Monday, March 15, 2021

MEDPAC Releases Annual Spring Report to Congress (531pp); Targets Genetics by Telemedicine

Each spring, MEDPAC releases a lengthy annual Report to Congress.   This year it weighs in at 531pp.

  • Full report here.
  • 24 page chapter on telehealth, telemedicine, here.
  • 3-page summary press release, here.

Nix Telemed Orders for DME and Genetics?

MedPAC formally recommends (page 470-471) that higher cost clinical lab tests (e.g. genetic tests) could be ordered only after clinicians provide at least one face-to-face visit with the patient within six prior months.  They note this is in response to cases where DOJ has charged 300 persons with submitting $6B in "false and fraudulent claims" (quote) of which $4.5B was related to telemedicine "without interacting with patients" or "only a brief telephone conversation" with patients.  

Note that Medicare already requires that a test-ordering physician must be treating the patient and managing his/her disease for which the test will be used (42 CFR 410.32).  A telemed doc who has a 1 minute call with the patient and never talks to her again, would not meet the "physician managing the disease" requirement.


There has been a radical expansion in telemedicine in Medicare under the COVID pandemic, and providers have been paid at office-based rates which are higher than facility-based rates.  MedPAC recommends continuing this for 1-2 years after the pandemic ends to "gather data," although they recommend that during this extension period, CMS cut payment rates to the facility-based rates regardless of the physician's location (e.g. office). 

Incident-To Under a Microscope

They recommend CMS collect data about incident-to services, focus on potential problems with incident-to telemedicine services, and prohibit incident-to billing if a provider can provide the service directly (e.g. a physical therapist or psychologist can bill Medicare directly; 471-472.)