Telehealth Is Healthcare’s New Frontier, Powered by MACRA

Perhaps the top priority for providers in the coming years is the successful transition from Meaningful Use to MACRA. The motivation for meeting the requirements of this transition is a series of compensation adjustments, both positive and negative. MACRA, or the Medicare Access and CHIP Reauthorization Act of 2015 is the bipartisan brainchild of the Centers for Medicaid and Medicare Services (CMS), which continues the shift from volumetric fee-for-service payment model, to one that incentivizes quality and value.

The CMS differentiates telemedicine from telehealth as services provided by a medical practitioner or non-medical services by administrative staff.  To prevent confusion in this article, I will stick to telehealth as the term used in discussion, of which telemedicine can be considered a subset of activities.

The recently released MACRA Final Rule demonstrates key opportunities to not only fulfill MACRA requirements (and in turn receive payment adjustments), but to find reimbursement in new frontiers of healthcare technology. Telehealth is one such frontier—innovative technology projected to become a 60-billion-dollar market by 2021.

Many EHR providers are struggling to cobble together telehealth technology platforms to support their current customer base, although few are yet successfully doing so at a price point that adds business value to these providers.

Many providers, especially the small and rural ones, are looking at telehealth as a viable option to grow their practice incrementally, without realizing it can possibly revolutionize a practice in many intangible ways. Telehealth can allow an already overburdened solo practitioners to spend more time with their family, or allow much more convenient access to care for handicapped patients.

So, let’s look at how telehealth intersects with MACRA, and telehealth will fit into the new value-based business model of healthcare.

Telehealth through MACRA

The most common method of MACRA participation is one of the two payment programs: the Merit-Based Incentive Payment System (MIPS) (the other being Alternative Payment Models).  MIPS grades providers on four performance categories (quality, cost, clinical practice improvement activities, and advancing care information), and aggregates each score into a composite score. For the purpose of MIPS scoring, the Final Rule distinguishes the difference between a patient-facing and non-patient facing encounter. A patient-facing encounter is one where a doctor interacts with a patient, remotely or not. A non-patient facing encounter is any procedure that does not involve direct interaction with a patient. Specialties like pathology or nuclear radiology have encounters where they do not directly face the patient; therefore their encounters are considered non-patient facing.   When you look at telehealth, it seems to blur the boundary between patient-facing and non-patient facing. However, MACRA defines this distinction, as they,”…include telehealth services in the definition of patient-facing encounters. Various MIPS eligible clinicians use telehealth services as an innovative way to deliver care to beneficiaries…”

Additionally, not every remote service is defined as telehealth. The Final Rule defines telehealth as, “…the use of telecommunications technology (real-time audio and video communication) substitutes for an in-person encounter. Services furnished with the use of telecommunications technology that do not use a real-time interactive communication between a patient and clinician are not considered telehealth services.” The CMS defines the list of telehealth services here.

What Telehealth Can Do for Your Practice

Providers will wonder whether it’s financially viable to adopt telehealth into their practice. Here are some benefits I find in telehealth:

Telehealth enables a far greater health footprint:

The ability to remotely treat patients creates an avenue of delivering care never before utilized by many providers. Telehealth increases options in outpatient care, which means doctors can visit a far greater number of patients through real-time audio and video communications. For example, the growing elderly population signifies an increase in incidents of chronic diseases—telehealth allows the elderly to be treated from the comfort of home, without having to come in.

Telehealth gives you a wider reach:

Many states allow for telehealth interstate licensing, which allows providers to treat patients, not in your general vicinity. Imagine the reach your practice has now, which is possibly limited by the bounds of a car ride. With telehealth, you can advertise across counties and state borders. The potential patient growth for providers with telehealth is outstanding.

Telehealth is efficient and potentially cost-saving:

In-house encounters take up much more time and resources than telehealth appointments, which means physicians may see a greater amount of patients during the day. Telehealth increases access to health care services not available to many patients, say bed-ridden or those in hospices. Telehealth can reduce avoidable hospitalizations for those in nursing homes, and is a viable option for potential clinician shortages around the world.

Telehealth can improve health outcomes:

The American Telehealth Association (ATA) lists some key services telehealth provides: primary care and specialist referral services, remote patient monitoring, electronic consumer and medical education—all of which can improve the outcome of patient encounters. Education and accessibility in health are crucial aspects that determine patient outcomes.

PrognoCIS and the Future of Healthcare

Healthcare technology is creating a paradigm shift in the way we approach healthcare. Healthcare is becoming more electronic, more interconnected, and more about sharing data for the betterment of patients and providers alike.  Whether its telehealth or other innovative healthcare tech, it’s important to stay on top of the game, and understand how innovation in healthcare tech intersects with the healthcare legislation.

MACRA is shaping up to be a very promising change to the way healthcare has been approached, and as with Meaningful Use, PrognoCIS will be ready to assists providers in dealing with the changes. Learn about PrognoCIS’ telehealth capabilities and how we’re preparing for MACRA.