With the announcement of the public health emergency extension on Friday, July 15, 2022, it’s a good time to review the effect COVID-19 has had on telehealth in the United States.
Telehealth, or telemedicine, has been a hot topic over the past few years due to the global COVID-19 health crisis. As scientists worked around the clock to stop this highly transmissible virus, most of us could just sit and wait.
To avoid getting sick, most people began avoiding potential infection hotspots. The demand for contactless and remote services increased dramatically, and companies transitioned more employees to remote work.
It’s no surprise that medical organizations had to expand their remote care capabilities to meet this demand.
TELEHEALTH JUST BEFORE THE GLOBAL 2020 HEALTH CRISIS
While the first instances of video telehealth occurred in the 1950s, the practice was uncommon for over half a century afterward. It was too early for widespread adoption.
While the technology to connect people remotely with video and audio transmission existed, it wasn’t the same as today. The accessibility of the necessary technology was a major barrier for the average person.
That’s why these earliest instances of remote care were set up between facilities. These rare instances of video transmission for telemedicine enabled healthcare professionals to help treat patients in locations without quick access to doctors.
It took time for the general population to largely have the technology required to conduct telehealth visits from home. Today’s smartphones can easily handle telehealth visits, but approximately 15% of Americans don’t have one.
While COVID-19 undoubtedly boosted the rate of telemedicine visits, the practice had actually been gradually growing quickly. This 2018 research letter found that telehealth visits compounded in frequency by 52% per year between 2005-2017.
The global health crisis began when telemedicine was already at an all-time high. Thanks to the federal government’s response to the virus, telehealth care surged to unprecedented levels.
Before the government declared a public health emergency, telemedicine services were poorly incentivized. Many healthcare professionals were still unsure how effective telehealth services could be for patient care.
As such, Medicare had strict requirements for covering telehealth visits. For Medicare payment for telehealth before the additional waivers, two things must have been true.
1: The patient lived in a designated rural area, and
2: The patient traveled to a medical facility for telehealth care.
If both of these factors were true, Medicare would reimburse telehealth visits at half the rate of regular in-office visits.
TELEHEALTH WAIVER 1135 EXPANSION
In 2020, there were approximately 62 million Americans dependent on Medicare for access to healthcare coverage. Once it was no longer always safe to visit healthcare facilities, these patients needed another option.
When the need for telemedicine increased beyond just rural areas with poor access to healthcare services, telehealth guidelines and requirements expanded to ensure accessibility.
The key features of Waiver 1135 expanded by the Centers for Medicare and Medicaid Services (CMS) to incentivize virtual care include the following:
Remote Care from Home
To eliminate the risk of appointments exposing patients to the virus, Medicare currently allows patients to access covered telehealth services from home.
Understanding that the existing telehealth regulations restricted access to the service for most patients, CMS wanted to ensure new patients could find a telemedicine provider. As such, healthcare providers can currently conduct telehealth appointments for both new and existing patients.
Additionally, almost all providers eligible to bill Medicare for patient treatment can now bill for telehealth reimbursement.
Interstate Licensing Requirements
To further enhance patient options, CMS currently covers telemedicine visits across state lines. This waiver is dependent on requirements set by the patient’s state, and the number of states offering interstate services has diminished.
As of Jul 12, 2022, only 12 states still have these temporary waivers in place. After experiencing the benefits of remote care, 20 states have imposed permanent telehealth expansions.
Expanded Compliant Telehealth Options
While previously telehealth services were only reimbursable for transmissions of both audio and video, CMS added additional options.
Waiver 1135 allows healthcare providers to bill for 3 types of remote healthcare services:
1: Medicare Telehealth Visits: Using telecommunication for a remote visit.
2: Virtual Check-In: A 5-10 minute telephone or other telecommunication chat or image/video submission to determine if an in-office visit is necessary.
3: E-Visits: Using an online patient portal for communication.
Healthcare providers can also currently supervise services through audio + video transmission.
Finally, during this public health emergency, authorized healthcare providers can prescribe controlled substances via audio + video communication.
WHAT HAPPENS AFTER THE PUBLIC HEALTH EMERGENCY?
When the COVID-19 public health emergency ends, the Consolidated Appropriations Act of 2022 guarantees a 151-day extension for most expanded policies. This provides a transition time so healthcare providers can adapt to the state of telehealth upon expiration.
Additionally, the Consolidated Appropriations Act of 2021 created new permanent telehealth updates. Rural emergency hospitals are now eligible Medicare-originating sites for in-office telehealth services.
Under this act, Medicare patients who’ve made at least one physical visit with a behavioral health professional can currently receive services at home. These services include counseling, therapy, and most other behavioral health services.
The American Rescue Plan Act of 2021 expanded funding for remote healthcare services to ensure future investment and accessibility.
Given the success of telemedicine, it’s not unlikely that more permanent improvements and incentivization will arise. When treating patients remotely, however, having their latest health information is essential.
ChartRequest helps healthcare providers request and release records faster to reduce the administrative cost and burden. We stay up-to-date on the latest care coordination and release of information regulations so you can focus on providing great care.