AJMC December Publications Address How to Pay for Telehealth

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The main barrier to widespread use of telehealth isn’t technology or consumer acceptance; it’s figuring out how to pay for it. Articles in the just-published issues of The American Journal of Managed Care and The American Journal of Accountable Care discuss why today’s payment models for accountable care organizations are a better fit for telehealth, and why regulatory changes make sense.

Aspects of paying for telehealth are discussed this month in articles in The American Journal of Managed Care and The American Journal of Accountable Care.

Under a proposed rule change, CMS could expand telehealth for accountable care organizations under the Affordable Care Act.

A proposed rule from the Centers for Medicare and Medicaid Services (CMS) could unleash the potential of telehealth to improve care for seniors with chronic conditions, if the agency lifts a barrier to paying for its use.

Author Krista Drobac, writing in the just-published issue of The American Journal of Accountable Care, addresses the CMS proposal in her article, “Telehealth: An Important Tool in Achieving the Goals of the ACO Program and Why Restrictions Should Be Lifted in Final ACO Rule,” Drobac’s is one of a pair of articles in December editions from The American Journal of Managed Care franchise that address the need to lift barriers to telehealth for accountable care organizations (ACOs), entities that were created by Congress as part of the Affordable Care Act (ACA).

In “Paying for Telemedicine,” a commentary in the December issue of The American Journal of Managed Care, author Robert Rubin writes that traditional fee-for-service models may not be appropriate for telehealth, as they could permit overuse. But newer models, and specifically those designed for ACOs, could allow the practice to expand, benefiting patients and producing savings. He cited a study of 3,000 congestive heart failure patients that received home monitoring of weight, blood pressure, heart rate and other measures. Readmissions—a key CMS metric in the ACO era—dropped 44%, saving $10 million.

Rubin also noted that one of the largest government healthcare providers—the Veterans’ Administration—uses telehealth extensively, even though regulations limit its use among Medicare recipients to those in rural areas.

Drobac’s article, which reflects the very recent CMS proposal, outlines how a longstanding Social Security provision limits telehealth’s use. However, she writes, ACA permits CMS to amend the rule to expand telehealth in ACOs, which makes sense today. Leading peer-reviewed journals are publishing more articles on how telehealth can be used to reach patients who have congestive heart failure, COPD, or have suffered strokes, which Drobac notes are common in the Medicare population.

“Overall, the findings demonstrate that telehealth enables providers to reduce unnecessary in-person care (emergency care and preventable inpatient admissions), while increasing patient access to timely primary care. Telehealth also allows providers to connect patients with appropriate specialists and coordinate care across clinical settings,” she wrote.

About the Journals

The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. The American Journal of Pharmacy Benefits, provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care. In December 2013, AJMC introduced The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

Mary Caffrey (609) 716-7777 x 144

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Mary Caffrey
American Journal of Managed Care
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Nicole Beagin
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