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A Medicare Advantage group and other organizations are endorsing legislation that would allow data collected during audio-only visits to be used to set risk adjustment payment levels to MA plans.
A coalition of provider and insurers is backing legislation that would allow audio-only telehealth visits to be used in the process that sets risk-adjustment levels that are a crucial part of the calculations for how much Medicare Advantage plans get paid.
The risk-adjustment issue, although of keen interest to Medicare Advantage plans, is just a slice of the large question about the future of audio-only healthcare, which in plainer English is a phone call between a patient and a provider.
Few doubt that telehealth has become a permanent feature of American healthcare because of the COVID-19 pandemic, even if use has slacked off some. Less certain is the audio-only version. Proponents say it opens up telehealth to people who don’t have good internet connections or devices capable of handling data-heavy video. A survey commissioned last year by the Better Medicare Alliance, a lobbying organization for Medicare Advantage, found that roughly a third of people below the federal poverty line have no internet access and that the same is true for a third of those ages 85 and older. Opponents say phone calls should only be used in limited circumstances and are not the means for conducting many healthcare encounters.
The Better Medicare Alliance is one of the groups backing federal legislation introduced in the House and Senate that would permit diagnoses arrived at through audio-only visits to be factored into risk adjustments to payments to Medicare Advantage. Other groups that signed a letter to the sponsors of the legislation included the Association for Community Affiliated Plans, the American Occupational Therapy Association, American Physical Therapy Association, and the U.S. Chamber of Commerce. The alliance put out a press release today. The letter is dated April 15.
“The data obtained through audio-only telehealth visits is necessary for accurate calculation of the following year’s benchmarks in Medicare Advantage, without which it will be difficult to keep out-of-pocket costs low for beneficiaries and meet expectations for use of supplemental benefits,” says the letter.
Payments to Medicare Advantage are risk adjusted to reflect the added cost of taking care of people that are sicker and have more illnesses that need to be managed or treated. The Medicare Advantages plans say that if the data obtained through audio-only healthcare encounters can’t be factored into their risk adjustments, they will suffer financially for paying for the care of patients who are sicker without the upward increase that risk adjustment would bring.
Many pieces of telehealth legislation have been introduced in Congress and a significant proportion of them include provisions that would make ayment for audio-only healthcare encounters permanent beyond the temporary allowance that was made as part of the response to the pandemic.