The Centers for Medicare & Medicaid Services (CMS) has made strides in providing more affordable, accessible care for all patients. A new rule allowing Medicare Advantage beneficiaries to access telehealth from home was recently proposed. CMS also released its CY 2019 Physician Fee Schedule final rule, which includes reimbursement for telehealth and virtual care services.

CMS’ proposed changes to Medicare Advantage will help enrollees obtain better access to healthcare via virtual care and telehealth. Instead of incurring travel costs and time to go to a healthcare facility for an appointment, Medicare Advantage beneficiaries will be able to participate in virtual visits from the comfort and convenience of their home. This change will be of tremendous value to MA enrollees who may have challenges in securing reliable transportation and may have to travel considerable distances in order to reach a provider or a hospital. This will commence in 2020 as part of the government-funded “basic benefits.”

According to CMS, the CY 2019 Physician Fee Schedule can support access to care using telecommunications technology. Medicare will pay providers for these kinds of services, including quick check-ins between patients and providers. CMS is also expanding the list of Medicare-covered telehealth services. The proposed ruling helps patients—whether rural or not—access care on their terms and helps increase provider adoption due to better reimbursement. 

The Cost of Chronic Conditions

Healthcare organizations are focused on better engaging and caring for patients with chronic conditions. Patients with chronic conditions face the risk of recurring readmissions, burdening the overall ecosystem with costs and complexities in providing the right kind of care, at the right time. The majority of older adults are living with chronic conditions; 92 percent of older adults have at least one chronic disease and 77 percent are challenged with at least two chronic conditions according to the National Council of Aging.

CMS indicates that chronic illnesses account for 75 percent of the $2.2 trillion spent annually on healthcare in the U.S. Investing in better disease management will impact health and financial outcomes, and offering affordable access to virtual care is one way to help these patients receive the treatment they need. 

Better Benefits for Patients and Providers

The recent CMS developments will help the chronic care patient population remain at home as they participate in the ongoing care needed to treat and manage their conditions. Patients will be able to receive care outside the four walls of a healthcare setting. By being able to participate in virtual visits and receive SMS, text, or email reminders about upcoming appointments, medication requirements, and diet/lifestyle recommendations, patients will be better informed, engaged, and involved in their care. As a result, these patients will be less likely to return to the emergency department or be readmitted as more providers leverage technology to monitor and motivate their patients on a consistent basis.

CMS’ initiatives will also help providers overcome some of the obstacles to telehealth and virtual care adoption. By updating the reimbursement structure, providers will be more inclined to utilize technology in their delivery of care. For example, home health agencies will recognize the benefits on their productivity and profitability.

Virtual care technology can help visiting nurses remain in more frequent touch with their patients by augmenting or even replacing many of their traditional in-home visits. The technology improves staffing productivity by enabling nurses to “put eyes and ears” on more patients vs. spending much of the day behind-the-wheel and en route to and from patients’ homes. Home health agencies will be able to expand their patient base and referral stream. By keeping patients at home—but still providing them with access to specialized care on-demand—nursing staff will help boost their revenue stream from referral sources focused on partnering with agencies that can help their CMS ratings. During a virtual visit with a patient, the nurse can quickly include a specialist to resolve patient questions in real-time and/or diagnose emerging conditions.

By addressing these concerns during the virtual visit, home health agencies are improving the timing, quality and impact of their care. Specialists will not always need to make a home visit to resolve the situation; patients will not necessarily need to return to the ER for specialized care. For many questions and conditions, nurses and specialists can remotely handle a patient’s issue in a timely and cost-effective way via technology. The use of virtual care will help home health agencies reduce patient readmissions, leading to improved quality scores and enhanced health and financial outcomes for all.   

The Value of Virtual Care

With CMS’ recent advancements in expanding access and reimbursement, patients, hospitals, and home health providers will realize the value of virtual care technology in helping patients stay on track with their treatment plan and address any issues which may cause unnecessary (and costly) readmissions. Patient and provider satisfaction will increase as the provided care is more efficient and effective for all stakeholders within the healthcare ecosystem.  

Lee Horner is the CEO of Synzi, where he is responsible for corporate strategy and development, with an emphasis on revenue growth, product direction and customer satisfaction.