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Telehealth is changing the face of healthcare, and Medicare must adapt, said the CMS administrator.

Innovation is vital to the evolution and sustainability of the American healthcare system, and the Centers for Medicare & Medicaid Services (CMS) is working to be part of the transformation, according to its administrator.

In a speech on Thursday to the Alliance for Connected Care Telehealth Policy Forum for Health Systems, CMS Administrator Seema Verma spoke about how “relentless innovation is a crucial driver in creating value across all industries.” She addressed the role of telehealth in the future of healthcare and reimbursement progress for 2019. In addition, she talked about how Medicare can serve as a barrier to innovation, as well as what CMS is doing to help patients control their healthcare data and resolve interoperability issues.

CMS has been working to create a foundation of innovation, she said. “It’s part of our larger vision of moving to a system that is value based—that rewards value over volume by bringing the best to patients.  When we start paying for value, we will foster innovation as providers look for ways to compete for patients by providing the highest quality care at the lowest cost.”

Healthcare innovation serves “as a catalyst to improving quality of care, enhancing access to care, increasing efficiency in the system, and lowering healthcare costs,” said Verma. “Undoubtedly, innovation is the fuel that powers the engine of progress and creativity. And while we’re on track for healthcare costs to represent one out of every five dollars of American GDP by 2026, it’s technology that will help ensure the sustainability of our healthcare system.”

Following are five takeaways from her presentation:

1. Telehealth is Changing Healthcare Delivery

“Telehealth,” said Verma, “is changing the very face of healthcare. Telehealth innovations could help usher in a new world of healthcare that is embraced by both patients and providers, that identifies new avenues of care delivery, and that improves the value of care by increasing its quality while lowering its cost.”

Among the advantages she cited:

  • Gives patients choices by providing another way to access care and seek new treatment options
  • Enhances connections with rural, elderly and disabled patients, where transportation issues can be a barrier to care
  • Enables patients to become active members of the care continuum outside of hospital settings
  • Promotes long-term engagement between patients and practitioners
  • Provides better management of patients with chronic conditions
  • Reduces costs by lowering readmissions rates, as well as unnecessary hospital visits through better care coordination.

“Historically,” Verma said, “telehealth has been used to connect patients who are in one provider setting to a specialist located at a distant site. But technology is moving quickly beyond that use, and CMS and Congress have to keep up. There’s no reason today that seniors shouldn’t be able to use their smart phones to connect to their doctors—especially as it’s what patients want and need, and leverages today’s technology and innovation.”

2. Medicare Can Be a Barrier to Innovation

Verma addressed her well-publicized concerns about Medicare for All in the context of innovation.

“Medicare’s rules and governing statutes are often a barrier to innovation, which is why I have significant issues with the Medicare for All proposal,” said Verma.  “We too often see new products that don’t fit into the existing payment system, set up by the law.”

“Now, sometimes, we can figure out a way to shoehorn new devices into the Medicare benefit design,” she continued.  You saw the Trump Administration do this when we clarified policy to ensure that Medicare beneficiaries with diabetes can use apps on their phones to get readings and data from continuous glucose monitors.  But again, this was not easy.  It took years.  Meanwhile, patients went without new technology that could improve their health. Many diabetics had this technology with their private coverage and when they entered Medicare – lost their access.”

“That’s why this Administration has taken action,” she said. “We want to make sure that people across the country can take advantage of telehealth—not just those in rural settings.

3. Medicare has Expanded Coverage for Telehealth Services

Next year Medicare will expand coverage for telehealth services. Among the services eligible for reimbursement in 2019:

  • Virtual check-ins by phone or video between patients and their physicians. Not only does this enhance patient convenience, it helps avoid unnecessary costs, she said.
  • Virtual consultations between physicians, plus evaluation of images and videos recorded remotely.
  • The recently released home health rule enhances the ability of home health agencies to use remote patient monitoring for Medicare patients. This allows patients to share more real-time data with providers and caregivers, said Verma, leading to more personalized care and improved health outcomes.

Also new for 2019, Medicare patients receiving home dialysis will be able to obtain monthly clinical assessments via telehealth from their homes. In addition, patients experiencing symptoms of an acute stroke will be able to receive telehealth services from mobile stroke units.

Verma said CMS has “also proposed options for modernizing and expanding telehealth through our CMMI [Center for Medicare and Medicaid Innovation] models and demonstrations. When providers take accountability for healthcare costs, we want to give them more flexibility to innovate, so they don’t have to come to CMS for permission to test a new approach to care delivery.  We’re particularly focused on using our waiver authority to spur innovation in the telehealth space.”

She continued, “These are exciting changes which will increase access to care, give patients new choices, and foster the type of innovations we need to strengthen Medicare and ensure its sustainability into the future.  And we know that, given Medicare’s size, whatever we do affects the entire healthcare market.

“Ultimately, whatever CMS is doing to promote telehealth,” said Verma, “it’s really all about one thing: To foster innovation and protect and strengthen the Medicare program in order to deliver on its promise to our elderly and disabled populations.

4. Patient Control of Health Records is a Priority

CMS is committed to moving forward MyHealthEData, an initiative by the White House Office of American Innovation to ensure that patients control their health information throughout their healthcare journey.

“The reality is that once information is freely flowing from the patient to the provider, it will help to spur innovation in the entire digital health information ecosystem,” said Verma. “Advances in coordinated, value-based and patient-centric care will be even greater than anything we can imagine today.”

Through MyHealthEData, she continued, “CMS has launched a data revolution that is sweeping the healthcare market and changing the way we think about healthcare data and information. We are liberating data that will drive innovation throughout the entire healthcare system, and create new tools and solutions that will allow the system to deliver better value to patients.

5. Interoperability is Essential

One of the most significant obstacles to innovation is lack of interoperability.

“We have to get the electronic health record and all medical devices to connect seamlessly to the EHR,” said Verma. “I’m committed to removing any and all bureaucratic and legal obstacles to machine, device, and EHR system interoperability.”

Overhauling the Meaningful Use Program to focus on Promoting Interoperability, serves as a significant step in the right direction, she says. “We’ve stated that hospitals that don’t give patients their data in the next two years will be penalized, and doctors’ incentive program will be tied to interoperability as well, pushing the system towards interoperability.  We did this because interoperability will spur the next generation of innovation.”

Mandy Roth is the innovations editor at HealthLeaders.

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