Of the nearly 500,000 end-stage renal disease (ESRD) patients undergoing dialysis, only 12 percent receive dialysis in-home despite it being preferable and cost-effective to both patients and payers.[i] In a recent speech to kidney disease patients and advocates, Health and Human Services (HHS) Secretary, Alex Azar, stated that Medicare was making a concerted effort to expand the utilization of At-Home Dialysis, including expanding telehealth services.
In March, Health Recovery Solutions published a blog post on the potential of telehealth to disrupt the current system of treatment for those living with end-stage renal disease (ESRD). The post highlighted several aspects of ESRD treatment, including: the cost of treatment to Medicare and other payor agencies, the preference of patients and families to receive treatment at home, and the need to increase engagement between patients and clinicians. Today, we revisit the utilization of telehealth to treat ESRD patients in the wake of recent CMS reimbursement changes.
Although most Medicare recipients still receive their health insurance coverage directly from the federal agency, the number of recipients that opt to receive coverage through Medicare Advantage, a private insurance alternative, is growing. The Center for Medicare and Medicaid Services (CMS) expects nearly 23 million people to enroll in Medicare Advantage (MA) plans in 2019. Although these plans are administered through private insurers, CMS rules place restrictions on what benefits the insurers may provide. These rules place limitations on MA telehealth benefits as well, and the telehealth services that are eligible for reimbursement.