The Congressional Budget Office (CBO) was created in 1974. Its task is to conduct economic analysis of the budget, and, when asked by Congress, to provide fiscal estimates of the potential impact of any given legislative proposal. This is commonly known as “scoring.” Advocates for meaningful and important changes in American domestic policy, even those with major bipartisan and bicameral support, often find themselves running into the CBO wall. If their legislation “scores high,” i.e: will cost public programs money, hopes of passage are quickly dashed.
The challenge is that CBO is bound by rules that don’t allow them to consider the budget in a dynamic way. They can only look at black and white estimates rather than how particular programs might cost money but save money on the other side of the ledger.
Such as been the plight of the telehealth community for more than a decade.
The Social Security Act (Section 1834m, but who’s counting) defines telehealth as only payable by fee-for-service Medicare when the enrollee is in a clinical, rural site.
Let’s pause here. Telehealth is a marriage of healthcare and technology. By definition it eliminates geographic barriers and balances provider supply and demand. When the aforementioned language was codified in the Social Security Act, telehealth was being used to connect patients in rural areas to specialists non-existent in those rural areas. The reimbursement rules made sense.
Said rules were created in 2001, some 7 years before the first iPhone made its debut; now telehealth apps make it possible for patients to get real time, synchronous, HIPAA compliant health care on their smart phones anywhere, anytime. Access anyone?
And, given the fact that approximately 68% of Medicare beneficiaries have 2 or more chronic conditions and 36% have 4 or more chronic condition, and CMS’ goal is clearly to improve care and reduce costs for this high need and high cost population, why is it that we aren’t expanding the concept of telehealth payment within Medicare and letting telehealth do its job?
Scoring (refer to above).
For many years and just as many legislative cycles, telehealth advocates, including those who have successfully implemented telehealth for their hospitals, health systems, health plans have been advocating for the need for reform within Medicare.
The wall they have hit every year, including this one, is CBO. The very agency that predicted telemedicine would cost Medicare $150 million in the first five years. The program has spent a mere $57 million over 14 years, according to the Center for Telehealth and eHealth Law
The Congressional Budget Office explained its position this way in 2015, “Because Medicare coverage of telemedicine is limited, CBO does not have extensive data that would help project how expanding such coverage would affect federal spending in the Medicare program.”