Proving the Business Case for the Internet of Things

ATA applauds CMS telehealth decision

Steve Rogerson
March 16, 2015
 
The American Telemedicine Association (ATA) has applauded the decision by the Centers for Medicare & Medicaid Services (CMS) to allow accountable care organisations (ACOs) to use telehealth services. The decision was made as part of the release of a payment and care delivery model – the Next Generation ACO – and extends coverage for telemedicine services to millions of Medicare beneficiaries.
 
The decision is significant because under this model, Medicare telehealth services can be covered without regard to longstanding rural and institution restrictions, requiring a beneficiary be located in a rural area and served at a health facility. For the first time, telehealth coverage will be extended to 80 per cent of Medicare beneficiaries living in metropolitan areas and from any service originating site, such as their home.
 
This decision gives Next Generation ACOs the ability to cover and reimburse for telehealth services just as Medicare Advantage (managed care) plans do now.
 
“For nearly four years, ATA has urged CMS to waive all the Medicare restrictions for all ACOs,” said Jonathan Linkous, CEO of ATA. “This is an important change in CMS policy and attitude. We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.”
 
Medicare ACOs are comprised of groups of doctors, hospitals and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their original Medicare patients. ACOs are patient-centred organisations where the patient and providers are true partners in care decisions.
 
The Next Generation ACO model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current MSSP pioneer model and shared savings programme. The goal of the model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare fee-for-service beneficiaries.
 
Included in the Next Generation ACO model are strong patient protections to ensure that patients have access to and receive high-quality care. As with other Medicare ACO initiatives, this model will be evaluated on its ability to deliver better care for individuals, better health for populations and lower growth in expenditures.
 
CMS expects about 15 to 20 ACOs to participate in the Next Generation ACO Model with representation from a variety of provider organisation types and geographic regions. The model will consist of three initial performance years and two optional one-year extensions.