AMGA, Physician Groups Urge Feds to Support Audio-Only Telehealth Services

April 28, 2020
The organizations contend that audio-only visits should be counted for risk adjustment and care coordination purposes

Although the government has provided various forms of regulatory relief for physician practices and their patients related to telehealth services during the COVID-19 pandemic, AMGA, along with a collection of with medical groups and independent practice associations from across the U.S., are urging federal health officials to additionally support audio-only telehealth services.

The letter to Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, from the Virginia-based association and dozens of provider groups, notes that clinicians have embraced the use of telemedicine during the COVID-19 outbreak, providing critical care for their patients while mitigating the spread of the disease.

“As stay-at-home orders were declared across the country, CMS has taken numerous steps to expand the use of telehealth to meet patient needs, including sweeping waivers and reimbursement changes in traditional Medicare. On April 10, 2020, the agency announced that diagnoses made during telehealth visits may now be submitted for risk adjustment purposes,” the letter stated.

Prior to this, CMS said it would temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country. Going forward, a range of healthcare providers will be able to deliver telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes, according to CMS. For the time being, this removes a historical barrier that limited telehealth visits from occurring only at certain locations designated by Medicare.

What’s more, part of the flexibility offered by CMS, per its March 30 announcement, includes allowing individuals to use interactive apps with audio and video capabilities to visit with their clinician. And, providers also can evaluate beneficiaries who have audio phones only. Importantly, however, the guidance released by the agency on April 10 notes, “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face requirement when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication.”  In other words, a standard landline or non-smart phone would not satisfy the face-to-face requirement when it comes to risk adjustment.

While AMGA and the providers participating in the letter applaud the loosening of many of these restrictions, they noted, that “the agency’s requirement that telehealth services be provided via live, audiovisual telecommunications remains a significant barrier for patients and physicians during the pandemic. A major component of telehealth services are audio-based services, or care provided over the telephone, which remains a straightforward and preferable alternative for many patients and physicians.”

Under current CMS rules, the letter notes, any diagnosis made during an audio-only visit with a patient cannot be used for risk adjustment purposes. “This restriction undermines both the financial stability of these physician practices and our patient care goals,” according to the organizations.

“Too many Americans lack the technology or broadband service necessary to receive care through video-based modalities,” said Jerry Penso, M.D., president and chief executive officer of AMGA. “Recognizing this need, clinicians have continued to provide care for these populations during the pandemic, using only audio-based services, including landline phones. This care should is vital to many patients who are unable to access audiovisual technology.”

As such, AMGA and its members have called for CMS to clarify that audio-only visits can be counted for risk adjustment and care coordination purposes. This policy adjustment would support the needs of physician practices across the country as they continue to provide coordinated, affordable patient care during and after this global pandemic, they stated.

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