While telehealth visits with providers are conducted from a separate site,  Medicare requires that the patient be physically present at a medical  facility such as a hospital, rural health clinic, or skilled nursing facility— referred to as the originating site—during the telehealth service. Selected Associations Report Telehealth and Remote Patient Monitoring May Improve Care for Medicare Beneficiaries, but Cited Coverage and Payment Restrictions as Barriers

Officials from selected associations representing providers and patients  rated the significance of certain factors that encourage the use of  telehealth and remote patient monitoring in Medicare as well as factors  that create barriers to their use. Officials with a payer association we  selected generally agreed with the assessments of the selected provider  and patient associations. Selected Associations Cited the Potential to Improve or Maintain Quality of Care as a Significant Factor Encouraging the Use of Telehealth and Remote Patient Monitoring in Medicare

Among the factors presented as potentially encouraging both telehealth  and remote patient monitoring use in Medicare, officials from selected  provider and patient associations most often rated the potential to  improve or maintain quality of care as very or somewhat significant. Officials from a provider association told us that telehealth can  improve patient outcomes by facilitating follow-up to care. Additionally, an  official from a patient association stated that remote patient monitoring is  a helpful tool for treating patients with chronic disease. Selected Associations Cited Payment and Coverage Restrictions as Barriers to the Use of Telehealth and Remote Patient Monitoring in Medicare

Among the factors presented as potential barriers to the use of both  telehealth and remote patient monitoring in Medicare, selected patient  and provider associations most often rated cost increases or inadequate  payment and coverage restrictions as very significant or somewhat  significant. For example, officials from a  provider association reported that Medicare’s telehealth policies for  payment and coverage lag behind other payers due to the program’s  statutory and regulatory restrictions. In particular, these restrictions limit  the geographic and practice settings in which beneficiaries may receive  services, as well as the types of services that may be provided via  telehealth and the types of technology that may be used. Second, CMS’s new Medicare  payment program allows participating clinicians to use telehealth, and to  some extent remote patient monitoring, to help them achieve some of the  goals of the payment program. See table 2 for  more information on the Medicare telehealth requirements waived for  these models and demonstrations. For example,  clinicians could use telehealth to coordinate care and, in some cases, to  reach patients in remote locations. Additionally, there are some instances  when clinicians can use remote patient monitoring to meet Merit-based  Incentive Payment System goals—for example, using home monitoring to  remotely gather information to determine a patient’s proper dose of blood  thinning medication. Agency and Third- Party Comments

We provided a draft of this report to HHS, DOD, and VA for review and  comment. These departments provided technical comments, which we  incorporated as appropriate. Appendix II: Scope and Methodology for Identifying Factors Affecting the Use of Telehealth and Remote Patient Monitoring

We administered a data collection instrument to selected associations  representing providers, patients, and payers to obtain information on the  factors that encourage the use of telehealth and remote patient  monitoring in Medicare or are barriers to their use. Appendix VII: Examples of Telehealth and Remote Patient Monitoring in Medicare Models and Demonstrations

The Patient Protection and Affordable Care Act created the Center for  Medicare & Medicaid Innovation (Innovation Center) within the Centers  for Medicare & Medicaid Services to test innovative payment and service  delivery models to reduce Medicare, Medicaid, and state Children’s  Health Insurance Program expenditures while preserving or enhancing  the quality of care.
Why GAO Did This Study

Telehealth and remote patient monitoring can provide alternatives to health care provided in person at a physician's office, particularly for patients who cannot easily travel long distances for care. Medicare pays for some telehealth services that are subject to statutory and regulatory requirements, such as requiring the patient be present at an originating site like a rural health clinic.
The Medicare Access and CHIP Reauthorization Act of 2015 includes a provision for GAO to study telehealth and remote patient monitoring. Among other reporting objectives, this report reviews (1) the factors that associations identified as affecting the use of telehealth and remote patient monitoring in Medicare and (2) emerging payment and delivery models that could affect the potential use of telehealth and remote patient monitoring in Medicare.
GAO reviewed agency documents and regulations and interviewed agency officials. GAO also selected nine general and medical specialty associations with expertise and interest in telehealth or remote patient monitoring—six provider, two patient, and one payer association—based on a review of relevant documents and literature and through background interviews. GAO interviewed representatives from each of the associations and collected information from the provider and patient associations through a data collection instrument.
GAO provided a draft of this report to HHS. In response, HHS provided technical comments, which were incorporated as appropriate.

What GAO Found

Selected associations representing providers and patients most often cited the potential to improve or maintain quality of care as a significant factor that encourages the use of telehealth (providing clinical care remotely by two-way video) and remote patient monitoring (monitoring of patients outside of conventional settings) in Medicare. For example, according to officials from a provider association, telehealth can improve patient outcomes by facilitating follow-up care, while remote patient monitoring is helpful for treating patients with chronic diseases. With regard to factors that create barriers, the selected associations most often cited concerns over payment and coverage restrictions. For example, officials from a provider association noted that Medicare telehealth coverage restrictions limit the geographic and practice settings in which beneficiaries may receive services. While not indicating how significant these factors are to Medicare, officials with a payer association told GAO that they considered these factors—also identified by the provider and patient associations—as either encouraging use or creating barriers to the use of telehealth and remote patient monitoring.
Medicare models, demonstrations, and a new payment program have the potential to expand the use of telehealth and remote patient monitoring. The Centers for Medicare & Medicaid Services, an agency within the Department of Health and Human Services (HHS), supports eight models and demonstrations in which certain Medicare telehealth requirements have been waived, such as requirements for the locations and facility types where beneficiaries can receive telehealth services. For example, the waivers allow beneficiaries to access telehealth in urban areas, or from their homes. Additionally, the use of telehealth and remote patient monitoring in Medicare may change depending on how many clinicians use them as a way to achieve the goals of the new Merit-based Incentive Payment System, which—starting in 2017—will pay clinicians based on quality and resource use, among other things. Under this payment program, clinicians can use telehealth and, in some instances, remote patient monitoring, to help meet the payment program's performance criteria. For example, clinicians could use telehealth to coordinate care or use remote patient monitoring to remotely gather information to determine a patient's proper dose of medication.