Bill Would Stretch Medicare Telemedicine to Physical Therapy, Bigger Populations

Expanding the use of telemedicine under Medicare is the goal of a recently proposed piece of bi-partisan legislation. The bill, known as the Medicare Telehealth Parity Act of 2014, is designed to create more parity between telemedicine and traditional in-person care. U.S. Representatives Mike Thompson (D-CA) and Gregg Harper (R-MS) introduced the bill. In reference to their motivation, Thompson said, “By expanding telehealth services, we can make sure the best care and the best treatments are available to all Americans, no matter where they live.”

Population Expansions

If the legislation becomes law, the expansion of telemedicine in Medicare will take four years and happen over three phases. According to a press release from Mike Thompson, all of the phases will expand the use of video conferencing as well as store-and-forward technologies in federally qualified health centers and rural health clinics. Store-and-forward technologies are systems where medical information, including data, x-rays, and videos are stored so they can be sent to other sites for evaluation. In phase one, these services would be expanded to counties within metropolitan statistical areas with populations less than 50,000. In phase two, the same services would be expanded to counties located in metropolitan statistical areas with populations of 50,000-100,000. In phase three, the services would reach counties located in metropolitan statistical areas with populations over 100,000.

Outpatient Therapy

A significant feature of the bill and a substantial change to current Medicare reimbursement is a provision that would allow for Medicare reimbursement of a growing number of outpatient therapy services. The expansion would include services like physical therapy. In addition to physical therapists, the bill would, throughout its phases, expand telemedicine reimbursement to cover, among others, the services of certified diabetes educators, speech language therapists, audiologists, respiratory therapists, and occupational therapists.

Access Changes

According to an American Physical Therapy Association analysis of the bill, the changes are a relatively significant departure from Medicare’s current association with telemedicine. Although Medicare does allow some reimbursement for telemedicine, the program limits reimbursement to the use of telemedicine in rural areas. The current paradigm requires patients to travel to “originating sites,” which are usually hospitals or physician offices. The new bill would expand permissible originating sites to include rural health clinics. The bill also includes a provision that would allow for a significant expansion in remote patient monitoring for some conditions, including diabetes, congestive heart failure and chronic obstructive pulmonary disease.