Wednesday, March 2, 2022

Telehealth Extension Introduced, But Would Block Telehealth Orders for Genomics

The US healthcare system, certainly for Medicare, is looking at a "telehealth cliff" when the emergency rules around telemedicine end.

On February 7, 2022, Sens. Masto (D NV) and Young (R IN) introduced the Telemedicine Extension and Evaluation Act.   JDSupra here.  S.3593 website here.

The bill apparently attempts to implement a MEDPAC suggestion in Spring 2021, recommending that CMS block telemedicine orders for genetic tests due to perceived fraud in this space (e.g. a telemed doc in Tennessee orders 1000 expensive genetic tests one morning for nursing home residents in Florida).

Draft Bill Impacts Genomics in Telemedicine

S.3593 contains language blocking orders for DME and "costly laboratory tests," the latter defined as tests in the top quartile of payments.   (A quick sort of the Medicare fee schedule places the top 1/4 of prices at $140 and up, but that's not volume-weighted).

The bill does allow telemedicine based orders when the patient is also an in-person patient of the provider.

See a  mid-December 2021 OIG report on genetics teste growth, and genetics test fraud (including telemedicine), entry point here.