Telemedicine: CY 2015 MPFS reportage and dangers of the echo chamber

Many of us are waiting with bated breath for CMS to broaden its coverage of telemedicine services. Upon the release of the CY 2015 MPFS, the American Telemedicine Association got a little ahead of itself in the excitement over some changes in the physician fee schedule, and announced that CMS had added payment for remote patient monitoring of chronic conditions (99091). In fact, CMS's response to the proposal that this and other E&M codes should be payable if provided via telemedicine was: "These services are not separately payable by Medicare. It would be inappropriate to include services as telehealth services when Medicare does not otherwise make a separate payment for them." (79 FR at 67600.)

This code is a "bundled" code; it is included within broader E&M codes and while a dollar value is assigned to it, no payment is made to a provider in that amount. I confirmed with CMS that my reading was correct. The ATA realized its initial error and pointed me to a presser with a correction about the physician fee schedule on its website.

While payment for remote patient monitoring of chronic conditions turned out to be a chimera – at least for now – payment for chronic care management services, previously discussed in the CY 2013 and 2014 MPFS Rules, has been finalized in the CY 2015 MPFS. CCM services provided by or on behalf of a primary care practice, to Medicare beneficiaries with two or more chronic conditions who opt in to the service, will be reimbursable at a payment rate of $42.60 PMPM. (If remote monitoring were also reimbursable, the payment would have been more than doubled, hence the excitement over the initially misunderstood regulation as a "Halloween telemedicine treat.")

In light of the perpetual need to fill white space, and an interest on the part of blogs and websites covering telemedicine reimbursement policy in reporting good news, the initial ATA presser received widespread coverage. (I found a dozen different websites and blogs that had cited the original presser by searching on a phrase it included.) Given the short news cycle and the general reluctance to revisit old news, the correction did not get the same sort of attention. (By my count, this post is only its second citation.)

I was reminded the other day of the advice given to me by an expert in legal ethics: Never post a tweet until it has been reviewed by your law partner. While implementing that advice may be impractical, there is an appropriate middle ground between immediate or rapid sharing of content and intensive peer review before publishing or re-publishing material. 

Bottom line: If something seems too good to be true, it probably isn't. Act – and communicate – accordingly.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting