The Facilities for Medicare and Medicare Providers ought to accumulate knowledge about telehealth use in dwelling well being to information policymakers in setting reimbursement charges for suppliers, specialists stated in the course of the Medicare Fee Advisory Fee’s September assembly on Friday.
CMS adjusted how the Medicare program pays suppliers beneath the house well being potential fee system in 2020 after Congress mandated modifications to these funds within the Bipartisan Finances Act of 2018. Underneath the Affected person-Pushed Groupings Mannequin, CMS moved from a 60- to 30-day fee unit and stopped basing funds on the variety of remedy visits to curb their use.
MedPAC tried to look at the affect of these modifications on dwelling well being, discovering a 20% decline in in-person visits final yr. The drop in in-person visits might have stemmed from the fee system not encouraging extra visits, in line with a MedPAC evaluation. But it surely’s unclear whether or not fee modifications or the pandemic contributed extra to the discount.
“I am not prepared to attract a conclusion but,” MedPAC Chairman Michael Chernew stated.
CMS’ lack of knowledge on telehealth use in dwelling 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 way of telehealth as a substitute.
“It is onerous to know what is going on on with out figuring out concerning the telehealth visits,” MedPAC commissioner Dr. Lawrence Casalino stated.
It is possible a mixture of each, however no actual figures can be found, making it difficult to measure dwelling well being utilization. In response to a MedPAC survey, 71% of dwelling well being companies elevated telehealth choices final yr. If MedPAC may have included telehealth visits in its evaluation, the measured lower in dwelling well being utilization most likely would have been smaller final yr, panel employees stated.
Not solely would amassing knowledge on telehealth use in dwelling well being make it simpler to find out whether or not CMS set funds accurately, it will additionally provide better perception into the standard.
“There are some companies that it looks as if you could possibly do fairly effectively over telehealth and others that possibly not as a lot,” MedPAC commissioner Stacie Dusetzina stated.
MedPAC will not suggest that CMS require dwelling well being suppliers to report their telehealth use, however the fee might describe the advantages of such a requirement in its March 2022 eport.
A latest CMS evaluation discovered that base funds beneath the brand new mannequin had been 34% above common prices in 2020, despite the fact 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 stated. “I assumed this mannequin would transfer us nearer to right-sizing or encouraging high-value care. And it looks as if possibly this can be a step within the flawed path.”