Northern Light Health Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, Oct. 8 -- Lisa Harvey-McPherson, vice president for government relations at Northern Light Health, Brewer, Maine, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Medicare Program; CY 2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; etc.". The comment was written and posted on Oct. 2, 2020:

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On behalf of Northern Light Health member organizations including four general inpatient hospitals, a regional trauma hospital, three critical access hospitals, a psychiatric hospital, nursing facilities, homecare and hospice providers and air/ground ambulance services, we thank you for the opportunity to provide feedback to CMS regarding telemedicine and payment rates impacting provider evaluation and management visits. We preface our comments noting that the Centers for Medicare and Medicaid Services has a national responsibility to implement changes and promulgate rules that promote access to care for Medicare beneficiaries in Maine and across the nation.

Medicare Telehealth

Expanding telemedicine services is an essential component of our health care delivery model during the COVID-19 pandemic. While our member organizations were engaged in telehealth services flexibilities offered by the various telemedicine waivers supported our ability to dramatically expand telemedicine service capacity caring for patients at home throughout the State of Maine. The positive impact to patient access is significant including transitioning outpatient behavioral health services to a telemedicine delivery model, pediatricians identifying early triggers for risk of child abuse and neglect in the home, access to primary care for patients in homeless shelters and so much more. We appreciate CMS's support for telemedicine as reflected in the proposed rule changes.

The rule proposes adding 9 codes to the list of telehealth services covered under Medicare to remain covered after the Public Health Emergency (PHE) ends. We support this proposal. The rule also creates a new category of telehealth codes designed for adding new Medicare telehealth covered services but on a temporary basis. We strongly encourage CMS to transition all of the temporary codes to permanent Medicare policy. We provided clinical services for these codes during the emergency period.

Unfortunately, the waivers having the most significant impact on our ability to sustain the growth in telehealth care and services require Congressional action. Home as an originating site of care is a core element of our telehealth program during the PHE.

Eliminating geographic barriers is also important as Maine MSA counties are large geographic regions with significant rural components. Continuing to allow a variety of health care professionals to deliver services via telehealth is also important, our patients have benefited from a variety of technology services including physical, occupational and speech therapy. We ask that CMS support Congress to transition these important changes to the Medicare telehealth benefit.

We also request that CMS telehealth payment policy reimburse both the clinical service and facility fees associated with each visit. We have learned a lot over the past few months about the facility related costs for telehealth services. While some may think costs decline, our experience is the costs are fixed costs irrespective of the technology delivery model and there are new costs specific to telehealth care including technology support education on use for patients at home and a new workflow. Examples of telehealth facility related costs include:

* Technology licenses, equipment

* Technical coordination support for patients to set up with Zoom, this is essential to assist patients to successfully engage with their clinician during the telehealth visit

* Telehealth consent and registration outreach by staff in advance of the technology visit. Written signatures require mailing and then scanning into the medical record. It is critically important to continue verbal consent for telehealth after the emergency ends.

* Post encounter activity including transferring clinical information into the patient medical record and/or patient portal

Fixed costs are real costs and it is important to understand that facility costs exist irrespective of the location of the provider and patient. Sustaining the success of telehealth must be aligned with reimbursement policy for clinical and facility-based costs. If costs for telehealth are not adequately recognized then CMS and beneficiaries risk losing the significant gains in telehealth care achieved over the past few months.

Payment for Evaluation & Management Visits

Payment changes reflected in this rule will have a differential impact on different practice specialties, the rule proposes to offset these and other payment changes with significant decreases to other payment amounts in order to obtain budget neutrality.

Northern Light Health strongly opposes the proposed E&M changes as the net impact to our providers results in a negative $3.9 million dollars in 2021. The changes fail to achieve the budget neutral rebalancing goal described in the rule, it is simply a net payment reduction.

Maine citizens are among the oldest in the country with a high incidence of chronic disease, many of which are dually eligible for Medicare and Medicaid. With Maine's heavy reliance on government payment (Medicare and Medicaid) for health care services, employment of providers to provide care as hospital employed providers is an economic reality. Providers are unable to sustain independent practice business models with governmental payments below the cost of providing care, charity care burdens and commercial insurance payments unable to offset the financial losses of independent practice.

Furthermore, implementing payment reduction at a time when hospitals and providers are experiencing historic financial losses due to the COVID-19 pandemic impact is irresponsible and fails to reflect the intent of Congress to financially support hospitals and providers to care for patients at this critical time.

We thank you for consideration of our comments as you proceed to publish the final rule.

Sincerely,

Lisa Harvey-McPherson RN, MBA, MPPM

Vice President Government Relations

Northern Light Health

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The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2020-0088-1604

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