CMS Proposes Expanding Telehealth Reimbursement After COVID-19

August 04, 2020 - Yesterday, President Trump signed the Executive Order on Improving Rural and Telehealth Access. Under this order, the Centers for Medicare and Medicaid Services (CMS) will expand telehealth benefits for Medicare beneficiaries.  

CMS is seeking input from the public to determine which telehealth services should be permanently covered.

The Executive Order calls for the expansion of telehealth services to be made permanent, particularly in rural areas where telehealth is particularly useful.

“Rural healthcare providers, in particular, need these types of flexibilities to provide continuous care to patients in their communities. It is the purpose of this order to increase access to, improve the quality or, and improve the financial economics of rural healthcare, including increasing access to high-quality care through telehealth,” the Executive Order states.

Accessing care in rural communities can be a challenge as limited transportation and hospital closures create barriers for patients to receive the care they need. When the pandemic struck, this was only intensified.  Telehealth promotes care access as patients do not need to physically be in the physician’s office to receive care.

The coronavirus pandemic saw an unprecedented rise in the use of telehealth. Lockdown orders kept many patients in their homes and others were fearful of entering a physician’s office given the risk of contracting COVID-19.

Medicare members in particular leaned on telehealth services as they are amongst the most vulnerable to the coronavirus. These patients could maintain their relationship with their provider and manage their chronic conditions while staying safe at home.

CMS reported the use of telehealth skyrocketed during the pandemic. There was an average of 13,000 telehealth visits per week prior to the pandemic. But in the last week of April alone, almost 1.7 million Medicare beneficiaries had a telehealth visit.

Virtual visits promoted public health advice to stay home and socially distance, so it is unsurprising that over 10.1 million Medicare members have seen their provider via telehealth since the pandemic. 

But covered telehealth services were limited before the coronavirus outbreak. In 2019, Medicare primarily covered virtual check-ins. These are quick visits where doctors could talk with a patient and decide if she needed to come into the office for care.  

During the coronavirus outbreak, this was not enough. Patients needed emergency care, chronic disease management, and a list of other services. So CMS expanded covered telehealth services to include 135 different services such as emergency department visits, primary care visits, initial inpatient and nursing facility visits, and discharge day management services. CMS also added flexibilities that eased telehealth care delivery.

“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for Americas seniors,” CMS Administrator Seema Verma said in an earlier press release. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively.”

Nearly half (43.5 percent) of all Medicare fee-for-service primary care visits were administered via telehealth in April compared to less than one percent in February, according to a recent Department of Health and Human Services (HHS) report cited in the Executive Order.

Many patients like telehealth appointments as they can be completed quickly from the comfort of their home. And patients do not need to worry about finding transportation to the provider’s office.

Providers also like telehealth appointments because they help maintain patient’s safety. Physicians can see more patients in a shorter amount of time when performing telehealth visits and maintain their relationship with patients seamlessly.

These services were not guaranteed to be covered after the pandemic. But the proposed rule will help telehealth’s use continue to grow.