Society Resolution on Telemedicine Unanimously Passes AMA House of Delegates

November 16, 2018
Health Policy

The Society brought forward a resolution to expand the use of telemedicine in the nursing facility that passed at the American Medical Association (AMA) House of Delegates’ (HoD) Interim Meeting in National Harbor, MD. Specifically, the resolution’s resolves stated:

RESOLVED: That our AMA advocate for removal of arbitrary limits on telemedicine visits by medical practitioners in nursing facilities and instead base them purely on medical necessity and collaborate with relevant national medical specialty societies to effect a change in Medicare’s policy regarding this matter under the provisions of Physician Fee Schedule (PFS) and Quality Payment Program (QPP); and be it further

RESOLVED: That our AMA work with relevant national medical specialty societies and other stakeholders to influence Congress to broaden the scope of telemedicine care models in post-acute and long-term care and authorize payment mechanisms for models that are evidence based, relevant to post-acute and long-term care and continue to engage primary care physicians and practitioners in the care of their patients.

In regards to the first resolve clause, the Society has been advocating for the removal of the once a month restriction of the provision of subsequent care services defined by CPT codes 99307-99310 via telemedicine. In its comments on the recent proposed physician fee schedule rule, the Society noted that nursing facilities are the only sector of health care where such a restriction exists and although the acuity and complexity of the patient population in the skilled nursing facility has increased, the provision of telemedicine services has been proved to reduce hospital readmissions, improve care, and save Medicare dollars.

The Society agrees that patients still need timely face-to-face visits; however, the use of telemedicine can actually increase the likelihood of a face-to-face visit due to a quicker diagnosis of a change of condition that may have typically required a hospitalization. The Centers for Medicare & Medicaid Services (CMS), however, did not change its stance in the PFS final rule that was issued in early November. The Society looks forward to working with the AMA and other stakeholders to enact changes that allow for telemedicine services to be furnished in the nursing facility when medically necessary.

On the second resolve, the Society has been engaged on legislation that would create a separate shared savings reimbursement model under the PFS for the provision of telemedicine. The legislation, the Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2018, in short would create a shared savings reimbursement model to contract with an outside provider group that would embed a 24/7 advance care life support (ACLS) certified individual into the nursing facility to deal with emergency situations with the goal of avoiding unnecessary ambulance transfers. The legislation does not call out the need for geriatrics or post-acute and long-term care-specific training of the groups or the individuals in the nursing facility.

While this legislation takes the right step in creating a reimbursement model to expand the use of telemedicine in the nursing facility, the Society has expressed concern that it would be limited to a very narrow use of telemedicine based on one specific model in one geographic location and would not provide reimbursement for the many models across the country that have already shown to be effective in the nursing facility. Those models utilize and train existing nursing facility staff and do not have requirements currently built into the RUSH Act. Changes to the language to allow more models would create more robust and better solutions to expanding telemedicine in this sector.

Prior to presenting this resolution to the AMA, the Society Board of Directors adopted a similar policy for the Society. The Society’s delegate, Eric Tangalos, MD, CMD, presented the resolution at the AMA and received supporting testimony from other societies. The resolution was then adopted as new AMA policy by a unanimous vote of the House.

The Society also reviewed hundreds of other resolutions that dealt with many important issues including opioids, gun violence, physician payment, and others.

For a full report from the AMA House of Delegates meeting, please visit https://www.ama-assn.org/hod-interim-overview.