Neonatal Telemedicine Could Save Medicare $186 Million

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The American Telemedicine Association (ATA) is appealing to Congress to amend the Social Security Act to allow states to expand the use of telemedicine for Medicaid enrollees with high-risk pregnancies and neonatal care needs. The ATA says the measure will save Medicaid up to $186 million over the next 10 years.

In its legislative proposal, released this week, the ATA calls for the establishment of birthing networks where Medicaid coverage of telemedicine services would be provided to maternal-fetal and neonatal care patients.

"Basically you're not allowed to [use telemedicine in this manner] now because of certain prohibitions ... to the use of telehealth, so we have to get rid of those and open up it up for reimbursement for this care," Jonathan Linkous, CEO of the ATA, told InformationWeek Healthcare. "There are about 200 telemedicine programs and they link to approximately 3,300 sites around the country. We would expect them to be the first ones to establish these birthing networks because they have the knowledge and the experience to start using this right away."

To convince lawmakers of the potential savings to the federal Medicaid program, the ATA asked healthcare business strategy organization Avalere Health to develop a federal cost estimate using Congressional Budget Office-style measures to calculate savings that would come from telemedicine's ability to coordinate care for high-risk/high-cost Medicaid pregnancies.

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Avalere Health relied on previous research from the Centers for Disease Control and Prevention, the Institute of Medicine (IOM), the American Academy of Pediatrics, and academic centers to determine costs, measure preterm-birth prevention, and examine telemedicine's impact on the delivery of care. Researchers also spoke with officials at the University of Arkansas' Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) program which has cost-effectively managed a birthing network in that state for nearly 10 years.

In a document outlining its research methods and conclusions, Avalere concluded: "Based on a review of the literature related to the use of telemonitoring for pregnant women, potential cost savings included a reduction in utilization of hospital and physician services."

According to a 2006 report from the IOM, medical care for preterm births cost $16.9 billion, and over 85% of that cost was generated in early infancy. "Avalere estimates that approximately 75% of the cost of early infancy care is due to neonatal intensive care unit (NICU) costs in the first few weeks post-delivery, as NICU costs are disproportionally greater than costs for other post-delivery services, such as follow-up pediatric physician visits," the document states.

According to Linkous, the report supports the need for birthing networks which can reduce the use of NICU services and maternal physician visits. The hope is that lawmakers, who seek to save money in the Medicaid program, will see value in the proposal and vote to amend the Social Security Act to clear the way for states to make it easier to establish birthing networks across the country.

"There is certainly support in Congress for child and maternal programs," Linkous said. "There has been a number of bills passed that don't have this particular component in it, but there has been a strong interest in this, plus the fact that this has been pretty well proven through the study that it will save dollars. It won't cost the taxpayer anything."

The document also concluded that birthing networks could leverage telemedicine technologies to more effectively treat major conditions associated with high-risk pregnancies, including preterm labor, gestational hyptertension, mild preeclampsia, and gestational diabetes mellitus.

To encourage provider adoption, the proposal uses a shared savings approach, as well as a 90% contribution from the federal government in the first two years to encourage state adoption. The ATA is hoping Congress will pass the legislative proposal next year.

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