CMS ought to acquire residence well being telehealth knowledge, consultants say

The Facilities for Medicare and Medicare Companies ought to acquire knowledge about telehealth use in residence well being to information policymakers in setting reimbursement charges for suppliers, consultants mentioned in the course of the Medicare Cost Advisory Fee’s September assembly on Friday.

CMS adjusted how the Medicare program pays suppliers underneath the house well being potential cost system in 2020 after Congress mandated adjustments to these funds within the Bipartisan Price range Act of 2018. Beneath the Affected person-Pushed Groupings Mannequin, CMS moved from a 60- to 30-day cost unit and stopped basing funds on the variety of remedy visits to curb their use.

MedPAC tried to look at the impression of these adjustments on residence well being, discovering a 20% decline in in-person visits final 12 months. The drop in in-person visits could have stemmed from the cost system not encouraging extra visits, in accordance with a MedPAC evaluation. But it surely’s unclear whether or not cost adjustments or the pandemic contributed extra to the discount.

“I am not prepared to attract a conclusion but,” MedPAC Chairman Michael Chernew mentioned.

CMS’ lack of knowledge on telehealth use in residence well being complicates issues as a result of the company and MedPAC cannot decide whether or not Medicare beneficiaries went with out help or accessed assist by means of telehealth as an alternative.

“It is arduous to know what is going on on with out figuring out concerning the telehealth visits,” MedPAC commissioner Dr. Lawrence Casalino mentioned.

It is doubtless a mixture of each, however no actual figures can be found, making it difficult to measure residence well being utilization. In response to a MedPAC survey, 71% of residence well being businesses elevated telehealth choices final 12 months. If MedPAC may have included telehealth visits in its evaluation, the measured lower in residence well being utilization in all probability would have been smaller final 12 months, panel workers mentioned.

Not solely would accumulating knowledge on telehealth use in residence well being make it simpler to find out whether or not CMS set funds accurately, it could additionally provide higher perception into the standard.

“There are some providers that it looks like you could possibly do fairly nicely over telehealth and others that perhaps not as a lot,” MedPAC commissioner Stacie Dusetzina mentioned.

MedPAC will not suggest that CMS require residence well being suppliers to report their telehealth use, however the fee could describe the advantages of such a requirement in its March 2022 eport.

A current CMS evaluation discovered that base funds underneath the brand new mannequin had been 34% above common prices in 2020, regardless that the company had accounted for supplier upcoding when it set the charges. Suppliers objected to CMS’ methodology and threatened to sue if CMS tries to claw again overpayments.

“That is actually disappointing,” MedPAC commissioner David Grabowski mentioned. “I assumed this mannequin would transfer us nearer to right-sizing or encouraging high-value care. And it looks like perhaps this can be a step within the fallacious path.”

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