Bill Overview
Title: To amend title XVIII of the Social Security Act to permit the use of telehealth for purposes of recertification of eligibility for hospice care.
Description: This bill permanently allows, for purposes of hospice care recertification under Medicare, physicians and nurse practitioners to fulfill the requirement of a face-to-face encounter with the hospice patient via telehealth.
Sponsors: Rep. Miller, Carol D. [R-WV-3]
Target Audience
Population: People receiving hospice care globally
Estimated Size: 1600000
- Hospice care generally involves individuals who are terminally ill, which includes patients who are given a prognosis of six months or less to live.
- Hospice care is primarily utilized by older adults, as it is part of the Medicare program, which mainly serves those aged 65 and over.
- Telehealth expansion can significantly ease access for patients in remote or underserved areas.
- The change in legislation specifically impacts healthcare providers who will leverage telehealth technology to conduct face-to-face encounters.
- Since the bill pertains to Medicare, the major part of the target population resides in the United States. However, the total number of hospice patients globally is higher, considering different national healthcare programs.
Reasoning
- The policy will primarily impact elderly patients or individuals in palliative care, for whom physical travel poses a significant burden.
- Hospice care provisions are utilized by patients with limited life expectancy, many of whom are 65 and older.
- The telehealth provision will likely be most beneficial to those in remote areas where access to healthcare services is limited.
- The budget constraint indicates that implementation costs must remain within reasonable limits. Considering a population of 1.6 million in the U.S., the initial budget can accommodate the necessary technological adaptations for roughly $31 per patient in the first year.
- Most hospice patients in the U.S. will find their wellbeing improves with continued access to care, security, and potential adjustments of treatment plans made easier via telehealth.
- A significant portion of the impacted population will experience medium to high improvements in wellbeing due to reduced travel stress and more regular care assessments.
Simulated Interviews
retired teacher (rural Alabama)
Age: 78 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 3/20
Statement of Opinion:
- Telehealth would be a godsend. It's so hard to make it to the doctor's office every time for something like hospice recertification.
- Having the ability to have these face-to-face encounters from home would mean less stress and more comfort.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 3 | 3 |
| Year 20 | 0 | 0 |
retired engineer (urban New York City)
Age: 85 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 1.5 years
Commonness: 4/20
Statement of Opinion:
- Telehealth can save a lot of trouble for residents in my facility, but for me, either way, personnel are around to help.
- I see it being more beneficial for people who live alone or in rural areas.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 4 |
| Year 5 | 4 | 3 |
| Year 10 | 0 | 0 |
| Year 20 | 0 | 0 |
retired nurse (suburban Ohio)
Age: 67 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 2.5 years
Commonness: 2/20
Statement of Opinion:
- Moving for appointments is a challenge and this would make it more bearable.
- I could see most appointments becoming easier to handle if telehealth is allowed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 5 | 3 |
| Year 5 | 4 | 2 |
| Year 10 | 2 | 0 |
| Year 20 | 0 | 0 |
retired farmer (rural Montana)
Age: 92 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 3.0 years
Commonness: 1/20
Statement of Opinion:
- It's a blessing if I don't have to travel as much anymore.
- Sometimes the nearest clinic is hours away with difficult weather conditions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 4 | 2 |
| Year 5 | 3 | 1 |
| Year 10 | 2 | 0 |
| Year 20 | 0 | 0 |
retired secretary (urban Atlanta)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 4/20
Statement of Opinion:
- I like the idea of telehealth, but I'm already well-cared for here.
- It makes sense to allow flexibility for those less fortunate.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 0 | 0 |
retired social worker (rural New Mexico)
Age: 62 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 3.5 years
Commonness: 2/20
Statement of Opinion:
- It could greatly improve my quality of life by conserving energy, which is precious when you have ALS.
- Travel can be a huge task, and this change might keep my condition stable longer.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 4 | 3 |
| Year 10 | 0 | 0 |
| Year 20 | 0 | 0 |
retired chef (urban Los Angeles)
Age: 80 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 1.5 years
Commonness: 5/20
Statement of Opinion:
- It’s comforting to know I’d get less invasive follow-ups and could save resources.
- For someone vibrant, I'm quite happy with this advancement.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 8 |
| Year 2 | 9 | 7 |
| Year 3 | 8 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 0 | 0 |
retired bank manager (urban Miami)
Age: 69 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 1.0 years
Commonness: 4/20
Statement of Opinion:
- I see the benefit, but my condition requires frequent screening visits anyway.
- Though telehealth is valuable, I'm normally in the system often for other treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 4 | 3 |
| Year 5 | 3 | 2 |
| Year 10 | 2 | 0 |
| Year 20 | 0 | 0 |
retired postal worker (rural Texas)
Age: 75 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 3.0 years
Commonness: 3/20
Statement of Opinion:
- Traveling is difficult with my breathing issues, so telehealth for hospital procedures would be great.
- It should have been an option long ago for folks like me in rural communities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 4 | 2 |
| Year 5 | 3 | 1 |
| Year 10 | 0 | 0 |
| Year 20 | 0 | 0 |
retired librarian (suburban Illinois)
Age: 81 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 0.5 years
Commonness: 5/20
Statement of Opinion:
- For those in higher cognitive control, it might provide more self-agency.
- My care facility handles most logistics, and telehealth wouldn't change my direct experience much.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 4 | 4 |
| Year 3 | 3 | 3 |
| Year 5 | 2 | 2 |
| Year 10 | 0 | 0 |
| Year 20 | 0 | 0 |
Cost Estimates
Year 1: $50000000 (Low: $30000000, High: $80000000)
Year 2: $45000000 (Low: $27000000, High: $72000000)
Year 3: $40000000 (Low: $24000000, High: $64000000)
Year 5: $35000000 (Low: $21000000, High: $56000000)
Year 10: $30000000 (Low: $18000000, High: $48000000)
Year 100: $15000000 (Low: $9000000, High: $24000000)
Key Considerations
- Initial costs for telehealth infrastructure setup may be significant but will decline over time as technology and processes stabilize.
- Compliance and regulatory oversight on telehealth quality and delivery must be established to ensure high standards of patient care.
- Adoption rates amongst eligible patients and providers will determine overall cost-effectiveness.