Telehealth is Here to Stay | Citizens Against Government Waste

Telehealth is Here to Stay

The WasteWatcher

Various deregulatory measures by the Trump administration put in place to address the coronavirus, or SARS-CoV-2, has helped to increase the use telehealth.  Prior to the pandemic, Medicare would only pay for telehealth on a limited basis, like when a beneficiary is located in a rural area or when the patient leaves their home and goes to a clinic, hospital, or other designated medical facilities.  Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced on March 17 that under a 1135 waiver, Medicare would pay physicians to provide telehealth services to all beneficiaries on a temporary basis.  A 1135 waiver allows the Department of Health and Human Services (HHS) to take actions beyond normal activities when a disaster is declared by the president under the Stafford Act or National Emergencies Act.

The purpose was to allow all Medicare beneficiaries to “visit” their provider without having to leave their home and take the chance of being exposed to the coronavirus.  While telehealth had been growing in general, primarily due to the ownership of computers, tablets, and smart phones, other issues stifled real growth like privacy laws, state licensing laws, and reimbursement requirements.  The deregulatory actions taken by the Trump administration during SARS-CoV-2 pandemic greatly expanded its use.

Under the waiver, Medicare will pay providers for office, hospital, and other visits utilizing telehealth, including when it takes place in a patient’s residence, whether rural or not.  Providers include doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers.  There are three types of services that can be provided via telehealth: Medicare visits, virtual check-ins when a patient has an established relationship with the provider, and e-visits or non-face-to-face patient-initiated communications using an online portal with their doctors.

On April 23, CMS Administrator Verma also reached out to states, provided guidance, and encouraged health officials to broaden the use of telehealth in the Medicaid and Children’s Health Insurance Program (CHIP).  She said, “While not all patient interactions can be delivered through telehealth, our clinicians on the frontlines need every tool in their arsenal to fight this invisible enemy.  I’m urging states to use this toolkit to make sure our Medicaid patients, particularly our children, can continue to receive needed care from the safety of their homes.”

The Department of Health and Human Service’s Office of Civil Rights (OCR) also helped with easing privacy concerns using telehealth.  The office stated, “OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”

The Families First Coronavirus Response Act, which was enacted on March 18 and later amended by the CARES Act, required group health plans and private insurance to not charge patients any cost sharing for COVID-19 testing, including telehealth.  As a result of this action, there is similar growth using telehealth within the private sector.

The President’s Council of Economic Advisers (CEA) stated in an April 28 policy paper that “data show that telehealth utilization is increasing because of new flexibilities for the provision of Medicare telehealth services and potentially because of HHS’s policy change that allows providers to use popular video platforms to connect with patients.”

The CEA showed in the graph below that from March 14 to April 1, private insurance claims for telehealth climbed significantly.  The data is used is upper respiratory infection claims because of COVID-19 symptoms.  Decreasing urgent care and hospital out-patient care tracked closely with increase use of telehealth.  CEA stated, “By lowering demand for in-person care, telehealth has helped the United States healthcare system avoid exceeding capacity during this national emergency.  Importantly, telehealth can also reduce the negative health outcomes that come from delaying non-COVID-19 care for conditions that require urgent attention.”

The CEA believes that the increased use of telehealth likely helped people avoid crowded emergency and doctor’s waiting rooms and helped slow the spread of the virus.

The Wall Street Journal reported that CMS telehealth visits increased from 100,000 to 300,000 per week as of March 28 and that its use is likely to increase.  Because of telehealth’s success, it looks as if CMS Administrator Verma wants to keep this valuable tool permanent.  She said, “I think the genie's out of the bottle on this one. I think it's fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there's absolutely no going back.”