The Alliance for Connected Care is petitioning the Centers for Medicare & Medicaid Services' (CMS') new administrator, Mehmet Oz, M.D., to act on digital healthcare regulatory issues.
Oz was confirmed April 3 by the Senate. After Oz affirmed the value of telehealth during a confirmation hearing in March, digital health lobbyists are asking him to follow through on policy reform.
The alliance wrote to Oz Thursday asking him to address issues in digital health regulation that apply to hospitals, hybrid providers and virtual-only providers.
The Alliance for Connected Care raised a slew of issue such as provider location reporting, reimbursement for remote patient monitoring and Medicare Advantage and Medicaid network adequacy standards. It also brought attention to policy challenges with direct supervision, virtual cardiac rehabilitation and telehealth interprofessional consultations.
The CMS has the authority on some of these issues to change regulation without additional congressional authority. On other issues, where the CMS’ authority is more limited—like telehealth prescribing and interstate licensing—the alliance requests the CMS publish thought leadership on the issues for other governing bodies to consider.
The group's No. 1 line item is the issue of provider address reporting in Medicare. Under current rules, Medicare providers must report the addresses of all locations from which they see Medicare patients via telehealth. This is a privacy issue for providers who may be required to report their home addresses on publicly accessible websites, and it adds undue administrative burden to practices, they say.
“A system reported that it would take their operations staff around 6 hours of work per provider, per year, to add and maintain an average of three billing addresses per telehealth provider,” the alliance quotes in its letter to Oz. “For a health system with more than 3,300 telehealth clinicians, that results in more than 20,000 hours of additional staff work per year. Another system found similar estimates, with more than 4,500 telehealth clinicians resulting in approximately 27,000 staff hours of additional staff work per year.”
The alliance leans on the Trump administration's attention to chronic diseases to argue for higher reimbursement for remote patient monitoring devices. It argues that reimbursement for RPM is declining to the point of nonviability for providers and beneficiaries, especially for the supply of the devices. Reimbursement has decreased significantly since the codes were enacted in 2019, and it urges the agency to reconsider the costs of the devices.
The advocacy group asked Oz to change the definitions used in determining whether Medicare Advantage and Medicaid provider networks are adequate for patient access. They want the definition to include telehealth in lieu of traditional time and distance standards.
Allowing direct supervision for telehealth care and for resident training is an issue for hospitals and outpatient providers. For services billed incident-to a supervising physician, the alliance argued that supervising providers don’t need to be available in person at a clinic but rather have immediate availability via telehealth.
For residents in training, the virtual presence of a supervising physician can expand the number of sites where a resident can train.
The CMS should allow the virtual provision of intensive cardiac rehabilitation, which includes services like exercise programs, education and counseling provided virtually to prevent cardiac events. The virtual services were proven effective during the COVID-19 public health emergency, the alliance said, and continuing the program would reduce transportation barriers and scheduling conflicts for patients.
Interprofessional consultations should be allowed to take place through telehealth with reduced billing restrictions, the alliance argues. It says many studies have shown that interprofessional consults take an average of 10 minutes, whereas the billing threshold for the service is 16 minutes.
The alliance wants Oz’s CMS to weigh in on the Drug Enforcement Administration’s (DEA's) ongoing rulemaking for prescribing controlled substances via telehealth. It argues the DEA does not have sufficient clinical expertise to understand the impact on providers that their prior restrictive proposed rulemakings would have.
The advocacy group asks for the CMS’ thought leadership on “duplicative state licensing requirements” that it says stifle healthcare delivery innovation and competition. It cites statistics that more than 80% of providers and patients like the ability to deliver and receive care across state lines.
While the alliance does not provide additional details on the duplicative requirements, it cites the Uniform Law Commission’s telehealth act that allows providers in states that have enacted the law to provide care between those states.