PPS may expand role of telehomecare
PPS may expand role of telehomecare
But telehealth visits’ don’t count toward coverage
The recent shift to a Medicare prospective payment system (PPS) may not have thrown open the doors wide to the use of telemedicine in home health, but it may have opened them just a crack.
William Dombi, Esq., vice president for law at the National Association for Home Care in Washington, DC, says the PPS will give agencies more flexibility in how they use Medicare payments, including funding new technology such as telehealth if they wish.
"I think it’s a good advance — the flexibility in the use of the PPS payment for alternative modes of delivery of service, whether it’s a respiratory therapist, a nutritionist, a dietician, or telehealth," Dombi says.
In fact, the changes brought about by PPS have already caught the eye of home health agencies hoping to provide care more efficiently. Bonnie Britton, MSN, RN, C, supervisor of special programs for University Home Care in Greenville, NC, says she has seen a dramatic increase in interest in telemedicine from other agencies in the past six months.
"I think it’s going to increase even further," she says. "I think by December, more agencies are going to [consider telemedicine] because they’re going to have to live through the first few months of PPS and realize where they’re losing the money."
But Dombi and Jon Linkous, executive director of the American Telemedicine Association in Washington, DC, say there are more steps the federal government must take before telemedicine can be completely integrated into home health.
"There’s been some reluctance by home care agencies to move into it, thinking that maybe, a year or so down the line, there might be a review by HCFA [Health Care Financing Administration] that might call into question some of their use of telehomecare as counted visits under the prospective payment system," Linkous says.
Prior to PPS, agencies were not allowed to bill Medicare for telemedicine "visits" between a nurse and a patient via a two-way audiovisual link. That stood as a major obstacle to agencies that had no other means — grants, insurance, private pay — to finance the technology.
With the advent of the PPS, Dombi says that restriction has been relaxed. Agencies now are free to use the episodic payments they receive from Medicare for alternative modes of care, including the purchase of telemedicine equipment and the costs of providing visits.
However, one thing didn’t change: Telemedicine visits still are not counted by HCFA as qualifying skilled visits for coverage purposes. Dombi says that’s an important point when it comes to determining low-utilization payment adjustments (LUPAs) or outlier payments.
"You’ll still have to have the face-to-face visits," he says. "Say you have a home health agency that sends a nurse out there four times and visits the patient 10 times with telehealth. That’s only four visits — that’s a LUPA."
Linkous says that even without being able to count telehealth visits, agencies still can see enough savings from the technology to make it worth the investment.
"If home care agencies can use existing funds to support telehomecare, there’s going to be great cost reduction, and at the same time, probably an increase in the level of care for their patients," he says. "Most home care services are losing money because they’re providing greater services than what’s covered, anyway. This is a way to help shave some of that excess loss that they’re already incurring."
Despite the limitations imposed by HCFA, both Dombi and Linkous say they see a gradual shift in the federal government’s acceptance of telemedicine. Dombi, for one, believes HCFA is reevaluating its position on the use of the technology. He notes that HCFA officials are trying to find a way to include the costs of telemedicine in cost reporting in order to track its use and effectiveness in keeping home health costs down.
"Two or three or four years from now, HCFA may want to rebase payment rates," he says. "We would want, and we believe they would want, too, to know how much it really costs to deliver care, including those telehealth and other alternative services. Especially if those services are the reason why the patients’ outcomes are the way they are. HCFA is looking at it and saying, we want to at least have a data record of those kinds of costs."
Both men say legislative efforts are under way to allow telehomecare visits to be counted as skilled visits. Linkous sees growing support in both the U.S. House and Senate for such provisions. He doesn’t know yet how long such an effort will take but is optimistic that the rules will be loosened enough to someday give telemedicine a substantial role in Medicare home health delivery.
"If you look at the growing demand for home care, we’re going to have to be there," Linkous says of the telemedicine industry. "It’s not going to be a question of if, it’s a question of when."
• Bonnie Britton, Supervisor of Special Programs, University Home Care, No. 6 Drs. Park, Greenville, NC 27835. Telephone: (252) 816-4028. Fax: (252) 816-7910. E-mail: [email protected].
• William Dombi, Esq., Vice President for Law, National Association for Home Care, 228 Seventh St. S.E., Washington, DC 20003. Telephone: (202) 547-7424. Web site: www.nahc.org.
• Jon Linkous, Executive Director, American Telemedicine Association, 910 17th St., Suite 314, Washington DC 20006. Telephone: (202) 223-3333. Fax: (202) 223-2787. E-mail: [email protected]. Web site: www.americantelemed.org.
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