President Trump signed an executive order on Aug. 3 to further expand access to telehealth services during the COVID-19 pandemic, especially in rural communities. Through this order, the administration is also taking action to extend the availability of certain telehealth services after the current public health emergency ends, via a new proposed rule.
According to federal health officials, during the public health emergency, the Centers for Medicare & Medicaid Services (CMS) added 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. Now, CMS is proposing to permanently allow some of those services to be done by telehealth, including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments.
CMS said that it is also seeking public input on other services to permanently add to the telehealth list beyond the public health emergency in order to give clinicians and patients time as they get ready to provide in-person care again. CMS is also proposing to temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the crisis ends. This will also give the community time to consider whether these services should be delivered permanently through telehealth outside of the emergency, officials believe.
These proposals are part of numerous proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues for the 2021 calendar year.
Federal officials pointed out that before the pandemic, only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July. These statistics, and others, and others were touted in a recent Health Affairs commentary from CMS Administrator Seema Verma. That piece further noted that according to Medicare fee-for-service claims data, beneficiaries, regardless of whether they live in a rural or urban area, are seeking care during the pandemic through telemedicine services. In rural areas, 22 percent of beneficiaries used telehealth services, while 30 percent of beneficiaries in urban areas did so.
“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,” Verma said in an Aug. 3 statement. “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…”
Hundreds of healthcare organizations have urged Congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. A recent letter from 340 industry groups emphasized the importance of providing telehealth services during the pandemic—care that would not have been able to be delivered without the loosening of prior restrictions.
Importantly, those groups noted that statutory restrictions within the Social Security Act and that the authorities granted to HHS and CMS through recent coronavirus legislation are limited to the COVID-19 public health emergency period, meaning that “Congress must act to ensure that the Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services.” Indeed, payment-focused telehealth changes are under the authority of Congress rather than HHS and CMS.
In a statement, Ann Mond Johnson, CEO of the American Telemedicine Association (ATA), said “We applaud the Administration, as well as telehealth champions in Congress for taking the necessary steps to ensure individuals receive the care they need during this national health emergency and indicating support for extending telehealth post-pandemic.”
However, that statement continued, “But there is more work that needs to be done, on both the federal and state levels, to cement these gains and make permanent the waivers put in place in response to COVID-19. The stresses on our healthcare system were well-documented prior to the pandemic – including crippling provider shortages, escalating costs, and an aging population – and will only be exacerbated as our nation begins to recover from this health crisis. We have an unprecedented opportunity to modernize our healthcare system and appropriately leverage the technologies already available to deliver quality care, improve clinical outcomes, and increase patient and provider satisfaction by integrating telehealth in our nation’s healthcare delivery.”
A boost for rural healthcare
Per the executive order from the White House, the federal government will soon announce a new model to test innovative payment mechanisms, aiming to ensure that rural healthcare providers are able to provide the necessary level and quality of care. This model should give rural providers flexibilities from existing Medicare rules, establish predictable financial payments, and encourage the movement into high-quality, value-based care, according to officials.
The administration will also work with the Federal Communications Commission (FCC) and other executive departments and agencies to develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.
What’s more, HHS Secretary Alex Azar will submit a report to the president regarding existing and upcoming policy initiatives to: increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals; prevent disease and mortality by developing rural specific efforts to drive improved health outcomes; reduce maternal mortality and morbidity; and improve mental health in rural communities.
White House officials noted that 57 million Americans live in rural communities and often “face unique challenges when seeking healthcare services, such as limited transportation opportunities, shortages of healthcare workers, and an inability to fully benefit from technological and care-delivery innovations.”
What’s more, in the last decade, 129 rural hospitals in the U.S. have closed, with financial distress being the strongest driver for risk of closure. According to federal officials, “Rural hospitals lack sufficient patient volume to be sustainable under traditional healthcare-reimbursement mechanisms. From 2015 to 2017, the average occupancy rate of a hospital that closed was only 22 percent. When hospitals close, the patient population around them carries an increased risk of mortality due to increased travel time and decreased access.”