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“No Going Back”: Seizing Remote Monitoring’s Moment to Build Long-Term Resilience

Leslie Krigstein

06.18.20

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Amidst the staggering loss and tragedy of the COVID-19 pandemic, it’s been heartening to witness what can be achieved in this country when crisis calls for bold action. Over the past months, healthcare’s digital transformation has been propelled forward, hastened by a sense of urgency and a spirit of resolve. Many regulatory barriers have been lifted and emergency funds deployed in this difficult time to ensure that every American in need of care can access it through technology-enabled services.

While much of the public discourse has centered around telehealth, there is a growing recognition that other digital health solutions, including remote monitoring, are critical both in our response to COVID-19 and ongoing. Just last week a bipartisan, bicameral bill was introduced by Representatives Xochitl Torres Small (D-NM) and Dan Newhouse (R-WA) and Senators Martha McSally (R-AZ) and Doug Jones (D-AL) to expand essential access to remote monitoring across rural America and on tribal lands during the COVID-19 Public Health Emergency (PHE). The ‘‘Increasing Rural Health Access During the COVID–19 Public Health Emergency Act of 2020” would make $50 million available for Virtual Health Pilot Program Grants administered by the Health Resources and Services Administration (HRSA) to facilitate use of remote monitoring technology to maintain or expand access to health care services during the PHE.

In stressing the urgency of this bill, Rep. Small stated in her press release, “COVID-19 has only heightened the importance of expanding telemedicine in rural communities. I’m proud to lead the introduction of bipartisan and bicameral legislation that would provide opportunities for rural providers across the district and nationwide to expand community-based services to reach more patients.” Referencing the situation in her home state, Sen. McSally suggested that “bolstering access to telehealth will help remedy these shortages by providing Arizona’s vulnerable populations with increased access to critical health services in the comfort of their own homes.”

During the June 17 Senate Committee on Health, Education, Labor and Pensions, Telehealth: Lessons from the COVID-19 Pandemic, Sen. Jones expressed this sentiment further stating, “Connectivity continues to be an issue and I think that remote monitoring can help bridge that divide.” In his written testimony prepared for the hearing, Joseph C. Kvedar, MD, President, the American Telemedicine Association (ATA), continued, “By effectively applying data science, many leading remote monitoring companies, such as Livongo Health, can contextualize health trends, determine which individuals might benefit most from a telehealth visit, and offer patients real-time, personalized and actionable recommendations on how to stay healthy – critical for individuals with chronic conditions.”

This new bill could not be more timely. Tribal communities have been among the hardest hit by COVID-19, while access to chronic condition care has become even more limited as clinics have been forced to restrict in-person visits. By building upon recent provisions in the CARES Act (which I wrote about here in March) lifting barriers for telehealth and remote monitoring, this new legislation will invest in and extend the benefits of these innovative services to those populations most in need.

Encouraging as it is to see this groundswell of momentum toward a new standard of care, it will only lead to lasting impact if key requirements that the federal government relaxed for the time period of the PHE are permanently eliminated. In particular, we recommend the following:

Waive cost-sharing and copays for remote monitoring technologies. Under current CMS flexibilities during the PHE, Medicare Advantage plans may waive cost-sharing for plan enrollees for remote monitoring, telehealth, and services to address the outbreak. Additionally, the Office of the Inspector General (OIG) is allowing for cost-sharing of telehealth services under enforcement discretion for Medicare Part B.

CMS should build on these policies and support Medicare Part B patients by waiving beneficiary copayments, deductibles, and coinsurance costs for remote monitoring and telehealth services during the remainder of the PHE and beyond. Especially as our country enters a recession and the ranks of the unemployed swell, we must alleviate the added financial burden for those managing chronic conditions -- not only in the interest of improving outcomes but also to reduce overall healthcare spending.

Ease the burden on all for initiating a remote monitoring program. CMS made the process of initiating remote monitoring less burdensome on all during the PHE. It waived the need for an in-patient referral for Medicare beneficiaries to begin a remote monitoring program. While lockdown orders and social distancing requirements made it essential to relax this requirement during the PHE, this should continue as the norm moving forward, allowing those who cannot travel easily or may be more susceptible to illness to initiate these programs without having to meet in-person with a clinician.

For the duration of the PHE, CMS also lifted the requirement for the beneficiary to have a pre-existing relationship with the provider and allowed consent for initiation of remote monitoring services to be gathered virtually and by support staff. These steps have made it easier on all to expedite the enrollment process, removing unhelpful hurdles and administrative tasks. To help the most people while reducing costs, this newly simplified and streamlined process should become the operating standard moving forward.

Waive originating site and geographic restrictions for the provisioning of telehealth services. With the passage of the CARES Act, CMS was able to ease current Medicare telehealth requirements during the PHE to enable beneficiaries to access telehealth from a wider range of providers and in the comfort of their homes. Allowing beneficiaries to receive care in their home will be critical ongoing as we look to modernize our healthcare delivery system and truly meet people where they are.

First-dollar coverage for telehealth and remote care in high-deductible health plans. Through the CARES Act, telehealth and remote care can receive first-dollar coverage under high-deductible health plans through the 2021 plan year. First-dollar coverage should be extended permanently so members can access these critical services without cost-sharing, regardless of whether their deductible is met, and still remain eligible to make and receive contributions to an HSA.

Just as millions of Americans used Zoom to connect with family and friends and tried online grocery shopping for the first time in this crisis, so did we sample the benefits at scale of telehealth and remote monitoring. As CMS Administrator Seema Verma herself put it recently, “the genie’s out of the bottle on this one...there’s absolutely no going back.” Nor can we afford to if we’re going to build resilience and readiness for future waves of COVID-19 or the next pandemic that strikes. As we know from an extensive study conducted in New York, the epicenter of the US outbreak, nearly everyone hospitalized with COVID-19 had chronic conditions -- 88% with two or more. The best way to be prepared for the next pandemic is to ensure fewer Americans are at-risk and vulnerable in the first place. Permanently expanding and lifting barriers to telehealth and remote monitoring services will make America healthier and more resilient for the long run.

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