Tuesday, December 1, 2015

MEDPAC Touches Telehealth

Federal government policy on telehealth has advanced slowly, even as we all read about the rapid growth of a multi billion dollar industry.   For example, in 2012, the Institute of Medicine published a workshop on telehealth (here).

On November 5, 2015, the MEDPAC held a one hour session to update on the Medicare program and telemedicine.  Its concise "issue brief" is here, the PowerPoint deck here, and the 50 page transcript of the MEDPAC discussion is here.

The Powerpoint deck is brief: CMS is limited by Congress to providing fairly narrow telehealth benefits and in a traditional telemedicine channel.   Medicare spending is minimal (about $14M in a $500B program).  The report notes that the VA uses telemedicine much more proactively.  Not mentioned by Medpac, but states like New York are also moving far ahead of Medicare policy (here).

Of equal interest to the deck, is the 50 pages of discussion by the MEDPAC panelists.  They acknowledge that Medicare fee for service benefits are very limited for telemedicine, and that private payers, ACOs, and the VA are moving considerably faster.  There is a fair bit of discussion whether easier telemedicine access would control, or drive up, costs (the risk of overutilization).   The MEDPAC staff structured the questions as whether telemedicine improves access, or convenience, or improves outcomes, or lowers costs.  Panelists frequently noted that telemedicine may be more rapidly incented in a capitated or ACO type of payment system.