HEALTHCARE IS GARY CAPISTRANT S ENIOR D IRECTOR OF P UBLIC P OLICY A - PDF document

TELEMEDICINE: HOME IS WHERE THE HEALTHCARE IS GARY CAPISTRANT S ENIOR D IRECTOR OF P UBLIC P OLICY A MERICAN T ELEMEDICINE A SSOCIATION W ASHINGTON , DC Gary Capistrant's expertise in health policy is based on over 30 years of experience with Medicare, Medicaid, and national health reforms. Mr. Capistrant's knowledge of health policy has lead him to become a trusted advisor to associations, innovative health providers and Wall Street investment analysts. He is also the former Director of Congressional Relations for the American Health Care Association, Staff Director of the State Medicaid Directors Association and Health Legislative Assistant for former Rep. Jim Corman. Mr. Capistrant earned a MA in Public Affairs from the Humphrey Institute at the University of Minnesota and he also earned a BA from the same University. OBJECTIVES: Participants should be better able to: 1. Understand the current landscape of telehealth policy; 2. Understand the major policy opportunities and barriers to telehealth. F R I D A Y , M A R C H 4 , 2 0 1 6 8 :0 0 A M

Mr. Capistrant has declared no conflicts of interest Telemedicine: related to the content of his Home is Where the Health Is presentation. Gary Capistrant March 4, 2016 1

Strong Consumer Wants Drivers 24 / 7 / 365 Aging population On-demand = greater demand & costs = provider shortages Convenience Ease Consumer technology savviness Choice Provider experience & acceptance Control Direct Ubiquity of telecommunications 2

Overview Major Telemedicine Means Multiple terms Video/audio conferencing variations of tele-, e-, m-, i-, remote ( real-time, synchronous) vs. EHR, HIT Store-and-forward Goal is simply “health” ( some delay, asynchronous) Range of apps Remote patient monitoring Solutions, not tech Robotic 3

Telemedicine is NOT New Barriers Clinically different Remove and oppose A service artificial government barriers Rural About the technology 4

Major Government Roles Major Public Payors Rendering Medicare - NO 1834(m) Reimbursement Physician services CMMI Regulation Medicaid - GO Research No federal law or reg restrictions Common requirements Resources Statewideness Comparability Readiness and recovery 5

Medicare Today QUESTION #1 How many Medicare special needs plans are specifically for chronic 33.1M in fee-for-service lung failure? 21 Next Generation ACOs A. 0 B. 7 16.3M in Medicare Advantage C.13 D.50 2.0M in Special Needs Plans 13 specifically for chronic lung failure 6

QUESTION #1 Medicare FFS Barriers How many Medicare special needs plans are specifically for chronic lung Limited live video failure? Only rural counties (20% of beneficiaries) Limited originating sites – not a home 66% Limited providers – not RT A. 0 Only specific procedures B. 7 No “store & forward” (recorded) 23% C. 13 No phone, fax, email 6% 6% D. 30 No remote patient monitoring for A. B. C. D. chronic conditions 7

QUESTION #2 QUESTION #2 Under fee-for-service Medicare, what is Under fee-for-service Medicare, what the telehealth coverage to a beneficiary is the telehealth coverage to a at home? 100% beneficiary at home? A. None A. None B. Only for rural beneficiaries B. Only for rural beneficiaries C. Only for those “homebound” C. Only for those “homebound” 0% 0% 0% A. B. C. D. D.Full D. Full 8

ATA State Gaps Analyses Medicare Bills CONNECT for Health Act S. 2484: Sen. Brian Schatz (D-HI) H.R. 4442: Rep. Diane Black (R-TN) Telehealth Enhancement Act H.R. 2066: Rep. Gregg Harper (R-MS) Medicare Telehealth Parity Act H.R. 2948: Rep. Mike Thompson (D-CA) 9

States’ Overall Coverage Parity for Private Insurance 10

50 State Medicaids Today QUESTION #3 How many state Medicaid plans now All cover imaging cover remote patient monitoring? 48 states cover something A. 0 36 home telehealth 17 remote patient monitoring B. 7 12 store-and-forward C.17 Managed care, esp. comprehensive D.50 risk-based 11

States’ Medicaid Coverage QUESTION #3 How many state Medicaid plans now cover remote patient monitoring? 57% A. 0 B. 7 C.17 17% 17% 10% D.50 A. B. C. D. 12

States’ Physician Practices States’ Medicaid Home Health Coverage 13

License at Both Ends “One State License” Bills For Medicare Multi-state licensure compacts TELEmedicine for MEDicare Act Expedited S. 1778 by Sen. Hirono (D-HI) physicians H.R. 3081 by Rep. Nunes (R-CA-22) Reciprocity For Department of Veterans Affairs nurses VETS Act psychologists S. 2170 by Sen. Ernst (R-IA) physical therapists H.R. 2516 by Rep. Rangel (D-NY-13) “One state license” model 14

QUESTION #4 QUESTION #4 For interstate telehealth, is there any For interstate telehealth, is there any legal basis for the Federal legal basis for the Federal Government not to follow state laws? Government not to follow state laws? 42% A. Yes, because of federal A. Yes, because of federal sovereignty 31% sovereignty B. Yes, because of the “interstate B. Yes, because of the “interstate 19% commerce” clause commerce” clause 8% C. Yes, both C. Yes, both D. No, because of states’ right in the D. No, because of states’ right in the A. B. C. D. 10 th Amendment to the 10 th Amendment to the Constitution Constitution 15

Some Problems Addressed Barriers of time and distance Delivery Problems Professional shortages Disparities in access to care Quality of care Address care delivery problems Hospital readmits, ER overuse Cost, access, quality, productivity Costs of delivery Convenience and patient choice 16

Innovative Pay Models Tweaks Opportunities Value-based purchasing Pay for performance Reforms Increase patient choice, outcomes, Bundling (services, time) convenience, satisfaction Case-mix Sharing (risk, savings, gains) Promote “value - based” innovative Salary-based payment and service Reference pricing, indemnity 17

Medicare Prospects Medicaid Prospects Parity Payment innovations Urban ACOs, bundles, medical homes Homes Medicare Advantage Community health centers Managed care flexibility Remote patient monitoring FFS Stroke Focused initiatives Chronic care Specialty – at-risk pregnancies, autism Chronic - health homes Sites – school-based 18

AmericanTelemed.org ATAwiki.org Gary Capistrant Chief Policy Officer GCapistrant@AmericanTelemed.org 202-233-3333 19