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Deregulation Makes Telehealth Booming During and Beyond COVID-19


One of the most significant impacts of the COVID-19 pandemic would be the unprecedented rapid growth of telehealth. The government, the Centers for Medicare & Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC) all advise using telehealth to expand access to essential health services in response to COVID-19. Let's have a look at a set of telehealth related survey statistics. With more than 70 percent of in-person visits cancelled, 76 percent of survey respondents indicated they were highly or moderately likely to use telehealth going forward, and 74 percent of telehealth users reported high satisfaction, compared with 11 percent use of telehealth in 2019.


As a matter of fact, telehealth has been evolving for about 40 years, slowly and insignificantly. Licensure, reimbursement, eligible services, and security concerns, as well as a combination of escalating costs, an aging population, and rising chronic health-care conditions have made telehealth familiar but not common in practice. However, as social distancing became a new normal responding to COVID-19, and with the immediate goal to protect healthcare providers to avoid exposure, here comes telehealth as a good alternative for traditional office visits. Telehealth is playing an essential role in the new delivery of health care services during the COVID-19 pandemic. There are various government's support policies behind the rapid development of telehealth.


Deregulation

The Trump administration has taken steps to loosen regulations and has encouraged states to follow. It allows telehealth to serve more patients, help mitigate the spread of the virus, and save more lives.

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak, CMS, Mar 17, 2020

On March 27th, 2020, The Coronavirus Aid, Relief, and Economic Security (CARES) Act was passed by Congress with overwhelming, bipartisan support and signed into law by President Trump, including provisions granting the CMS sweeping waiver authority to expand the use of telehealth for Medicare with unprecedented latitude during the COVID-19 public health emergency.


Earlier in the month (beginning on March 6, 2020), Medicare—administered by the CMS—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.


In response, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act on March 13, 2020. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).


Key changes to telehealth policies include:

  • Expands access to telehealth services, both for patients’ side and for physicians’ side. Patients in all settings, including in their home, and across the entire country, not just in rural areas, can receive telehealth services. Physicians can now provide more services to beneficiaries via telehealth, including emergency department visits. The services can be provided to either new or established patients.

  • Removes licensure concerns for healthcare providers. Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply. Also, physicians can provide telehealth services from their home.

  • Solves reimbursement restrictions for telehealth services. Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just services related to COVID-19. Physicians can reduce or waive Medicare patient cost-sharing for telehealth visits, virtual check-ins, e-visits, and remote monitoring services.

  • Further looses the constraints for seniors and rural patients. Importantly for physicians caring for seniors and rural patients who may not have internet access or a smartphone, physicians can now provide audio-only telephone evaluation and management visits for new and established patients.

Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic, CMS, Apr 30, 2020

On Apr 30, 2020, the CMS issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens, continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services. This wave of changes directed a historic expansion of telehealth services so that doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes. Beneficiaries thus don’t have to travel to a healthcare facility and risk exposure to COVID-19.


Key changes include:

  • More types of providers can deliver telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Many other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

  • More audio-only visits are eligible for reimbursement. CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits.

  • Rural health clinics and federally qualified health clinics providing telehealth services will be paid by CMS, as mandated by the CARES Act. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel.

  • The process of adding new telehealth services will be approved faster. Until now, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible.


It is important for all healthcare providers to acknowledge the fact that the COVID-19 emergency is far from over. New coronavirus cases are growing or flat in 48 US states, with 12 states hitting record high seven-day averages for daily new cases. For practices that have already implemented these virtual care solutions, the negative impact of this wave will be minimized in comparison to those who have not.


Everyone has a role to fight against the COVID-19 Pandemic. From the very beginning of the outbreak, MicMD has been committed and leading the way by making every effort to equip our clients with the foremost telehealth technology they need to expand their business. Not only do we provide the ready-to-use telehealth platform "MicMD-NOW" (Web, Android, iOS all compatible), but also we offer clients a fully customizable telehealth solution, including customized branding, features, and services. Contact MicMD team or explore more at MicMD website. It is easy to get started and we are ready to help.


Source:

1. McKinsey COVID-19 Consumer Survey, 2020

2. Remarks by President Trump at Signing of H.R.748, The CARES Act, Mar 27, 2020

3. President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak, Mar 17, 2020

4. Coronavirus Aid, Relief, and Economic Security Act or the CARES Act, CONGRESS.GOV

5. CARES Act Summary (HR 748) Key Telehealth Provisions, American Telemedicine Association (ATA)

6. CARES Act: AMA COVID-19 pandemic telehealth fact sheet, American Medical Association (AMA)

7. Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic, CMS, Apr 30, 2020

8. CMS expanded Medicare telehealth, Advisory Board, May 4, 2020

9. Cases and Deaths in the U.S., CDC

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