The ACA survives, but what’s the future for MACRA and telehealth?

With today’s tumultuous political climate, the future of healthcare in America is constantly going in different directions. The Republican health care plan that was intended to repeal and replace the Affordable Care Act (ACA) suffered a loss last week when it was pulled off of the House floor before the House could vote on the bill. After the news broke, House speaker Paul Ryan acknowledged that “[w]e’re going to be living with Obamacare for the foreseeable future​.” Since there is a small chance that this bill, or another one like it, will be introduced anytime soon, it is time to focus attention on legislation that narrows in on advancing healthcare reform. Specifically, how that legislation could advance the healthcare industry through telehealth.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the sustainable growth rate and established the Quality Payment Program as a new way of compensating providers. Within the Quality Payment Program are two separate tracks through which providers participate in the program: the Advanced Alternative Payment Models or the Merit-based Incentive Payment System. The difference between the two tracks focuses on the method of reimbursement, with participants in an alternative payment model receiving inventive payments while participants in the merit-based system receive performance-based payments.

Section 101(b) of MACRA describes the Merit-based Incentive Payment System. One of the areas in which physicians would be evaluated is through clinical practice improvement activities. Within this category, physicians are encouraged to participate in care coordination, including “timely communication of test results, timely exchange of clinical information to patients and other providers, and use of remote monitoring or telehealth.” Section 106(c) even mandates that the Comptroller General conduct a study on telehealth regarding how the meaning of telehealth varies, issues that facilitate or inhibit the use of telehealth, and the implications of using telehealth services more frequently.

Indeed, telehealth was mentioned enough within MACRA to lead telehealth experts to believe that it would play a central part in the rule promulgated by the Centers for Medicare and Medicaid Services (CMS). But, much to the dismay of many telehealth advocates, CMS’ final rule declined to intertwine telehealth into the mechanism that determines the merit-based payment system. According to CMS, the limits that Medicare imposes on paying only for live patient interactions in rural facilities forms the foundation for excluding telehealth from a majority of the final rule. Even though telehealth is largely absent from the merit-based system, CMS did allow for telehealth in many of the alternative payment models, including next generation accountable care organizations.

One primary reason why telehealth advocates support including telemedicine in plans for healthcare reform is because of the cost saving measures that they say telehealth brings them. Among these advocates are health plans such as Aetna, Anthem, and Humana who are all urging the Congressional Budget Office to consider their plans’ data when evaluating telehealth legislation. In addition to the health plans, academic medical centers and researchers have begun urging the Congressional Budget Office to consider non-Medicare data when writing future healthcare reform legislation​ that addresses telemedicine. Going forward, advocates intend to get behind a bill from the Hawaii Senator Brian Schatz, entitled the CONNECT for Health Act, to demonstrate to Congress, and especially CMS, that telehealth has the opportunity to effectuate significant savings in the future. As of right now, however, the Act remains dormant in the Senate after having been introduced and referred to the Committee on Finance in February of 2016.

Maria Marek is in her second year at the DePaul College of Law in Chicago. She hopes to achieve a certificate in Health Law in conjunction with her J.D. upon graduation in 2018. Maria is actively involved in the Mary and Michael Jaharis Health Law Institute, and is especially interested in health policy and regulations.