It’s no secret that the Affordable Care Act (ACA) has been changing the healthcare landscape since its enactment in 2010. The shift to a value-driven, consumer-oriented health care system has been a major boon for telehealth as providers and payers look for innovative ways to meet the ACA’s demands without endangering bottom lines.
So what does health reform mean for telehealth in 2013? Here are the ACA provisions to watch in the coming year:
Telehealth by the bundle.
Starting in 2013, the ACA will shift health care from inefficient fee-for-service payments with a national pilot test of bundled payments, conducted by the Centers for Medicaid and Medicare Services (CMS). Under ‘bundling,’ providers will receive one, fixed reimbursement for multiple services delivered during one episode of care.
Telehealth could be a key component in these bundled payment initiatives, according to the American Telemedicine Association. Benefiting from telehealth’s growing success as a tool for cost-effective, quality care, technologies like remote monitoring or telestroke included in a bundle could advance the outcomes the ACA envisions – less cost with better quality.
Including telehealth in bundles could also be a much-needed lift over one of the field’s most significant adoption hurdles – a lack of reimbursement. Measures that improve quality and lower costs that were not reimbursed for under the fee-for-service model are likely to become more appealing to administrators as they refocus efforts on value-driven health care.
Accountable care organizations (ACOs) and telehealth: a winning team.
ACOs are expected to grow in 2013 with more than 200 likely to be recognized, the American Medical Association reports. In January, CMS announced more than 100 new ACO contracts.
This rapid growth, along with start-up costs estimated as high as $12 million dollars, means there’s a lot riding on ACOs’ success, which will depend on how well providers communicate with one another and their patients. Team-based and patient-centered, ACOs require providers to collaborate and connect with patients beyond the walls of the doctor’s office.
“In order to make an ACO viable, the partners must facilitate communications both among medical partners and between patient and provider,” said Gordon Alloway, HTRC project director. “This means that telehealth capabilities previously overlooked, like remote monitoring, may come back into play.”
Telehealth can advance prevention efforts.
Starting January, the ACA added more provisions to expand access to clinical preventive services for Medicaid enrollees, a population with a high rate of chronic illnesses that contribute to high readmission rates. One in 10 Medicaid enrollees were readmitted within 30 days of their first discharge in 2007, according to a 2010 analysis from the Agency for Healthcare Research & Quality (AHRQ). Readmission rates will remain a focus in 2013 as hospitals work to avoid higher penalties that start in October when Medicare payment reductions increase to 2 percent.
The measures reinforce ACA’s central goal to refocus healthcare on prevention and tackle the growing challenge of chronic diseases. Each year 7 out of 10 people die from a chronic condition and treatment of these conditions cost $1.5 trillion of the nation’s healthcare dollars, according to the CDC. Without better chronic disease management and prevention, a 2009 Health Affairs study estimated healthcare costs could reach $4.2 trillion in 10 years.
The complex and pervasive nature of chronic diseases are cannot be managed only inside the walls of a healthcare facility. This adds weight to the role of telehealth, a delivery system that can help engage patients in their home.
For help navigating the ins and outs of the ACA and telehealth, please call HTRC at 1-877-643- HTRC.