AHA urges CMS to cover telehealth services for cardiovascular disease, stroke

The American Heart Association (AHA) released a policy statement urging the Centers for Medicare & Medicaid Services (CMS) to cover evidence-based telehealth interventions for all Medicare beneficiaries who suffer from cardiovascular disease and stroke.

As of now, CMS only covers telehealth for some patients at qualifying health facilities in rural areas. However, CMS created the Next Generation accountable care organizations program in 2015, which allows providers to waive geographic limitations on telehealth reimbursement.

The AHA’s statement was published online Dec. 20 in Circulation.

“With heart disease and stroke being leading causes of death in our nation, our health care system must continue to adapt to take full advantage of proven forms of treatment, like telehealth, that can effectively fight these deadly diseases and advance health care quality,” AHA CEO Nancy Brown said in a news release. “Barriers must be removed so that more Americans suffering from [cardiovascular disease] and stroke, regardless of where they live, can reap the benefits of this valuable type of care.”

The writing group that put together the statement noted that more than 55 million people in the U.S. suffer from cardiovascular disease, while nearly 7 million people are stroke survivors. The members added that cardiovascular disease costs the U.S. healthcare system more than $320 billion each year, and stroke costs $33 billion per year.

They defined telehealth as “the use of telecommunications and information technologies to share information and to provide clinical care, education, public health, and administrative services at a distance.” They added that telehealth encompasses several digital health technologies, including telemedicine, eHealth, connected health and mHealth.

As of now, they said that telehealth was not used often enough for patients with cardiovascular disease and stroke due to cultural, financial and legal/regulatory constraints.

“Substantial implementation of telehealth will likely transform the practice of medicine, just as other major innovations such as electronic health records and payment reform have, and may increase pressure on solo practices or small groups to adopt new technology and methods of practice,” the group wrote.

The writing group recommended that telehealth should be integrated into traditional ambulatory and hospital-based delivery models. The members also suggested that stakeholders develop quality metrics and management programs for telehealth.

Telehealth offers a few benefits, according to the members, including reducing transportation costs for people in rural or low-income populations and improving patient safety by providing continuous monitoring and transmitting real-time data between patients and providers. They also said telehealth can enhance patient engagement, reduce unnecessary or inappropriate use of services, increase patient access to medically necessary services, reduce nonadherence to medication protocols and enhance provider-to-provider communication.

The group noted telehealth reimbursement remains inadequate. For instance, although 48 states have Medicaid reimbursement for telehealth services, coverage varies widely. Further, commercial health plans often do not cover telehealth-based services unless they are mandated to cover them under state laws.

Still, the group mentioned that some states have enacted laws requiring commercial health plans to cover telehealth services to the same extent they cover in-person services. A few states have also required health plans to cover remote patient monitoring in the benefit package and require health plans to pay providers for telehealth services at the same or equivalent rate as an in-person service.

The writing group recommended that properly trained providers are deemed eligible to provide telehealth services, companies develop technology platforms for interoperability between systems and researchers examine the cost-effectiveness of telehealth interventions.

“Telehealth is not only a proven tool for increasing access to high quality cardiovascular and stroke care for many patients, but it also meets all of the National Academy of Medicine’s domains of quality,” said lead author Lee Schwamm, MD, of Harvard Medical School and Massachusetts General Hospital, in a news release. “It is recognized as safe, timely, effective, equitable, efficient and patient-centered care. With increasing physician shortages, rising costs and a burgeoning demand for treatment, telehealth can greatly improve value in health care and, most importantly, produce better health outcomes for all.”