Regulatory reforms such as relief from rules in virtual visits with physicians are playing a major role in helping Americans work through the growing changes caused by the COVID-19 pandemic.
The Centers for Medicare and Medicaid Services (CMS) is now reimbursing physicians for virtual visits or telehealth services, as well as phone calls with patients, at the same amount as an in-person visit. Effective on March 6, 2020, CMS lifted some restrictions in three areas: Medicare telehealth visits, virtual check-ins, and e-visits. All told, the changes involve more than 80 telehealth services and cover visits in all settings, including a patient’s home.
Congress had prohibited full reimbursement for virtual doctor visits, except in underserved areas, and in those cases, the patient had to log on at a hospital or clinic for the service. CMS made the changes under President Trump’s emergency declaration.
Telehealth, which allows patients to connect remotely with medical professionals, is an area where deregulation has empowered patients during the crisis and provided public health benefits. The remote nature of telehealth allows physicians to keep their practices open during the shutdowns while protecting themselves and others from those who may be contagious with the coronavirus or other illnesses.
Telehealth has also reduced the burden on hospital emergency rooms by enabling providers to screen patients safely to determine whether they need such intensive care, before they come to the ER. Telehealth is particularly advantageous for elderly individuals, who are more susceptible to COVID-19. Virtual visits have also allowed private physician practices to stay open during state shutdowns.
“We are glad CMS heard our concerns about physician practices,” said Robert McLean, M.D., American College of Physicians president in a news release. “The changes by CMS will help practices by providing them with revenue to keep their practices open as they move away from in-person to virtual ones.”
Removal of Billing Obstacles
Providers are required to use an interactive audio and video telecommunications system so real-time communication can occur between the provider and patient at home.
Although the billing change provided some clarity to health care providers, it overlooked the fact that patients may not have video capability at home. That meant providers would be unable to bill CMS for helping those patients through remote audio consultation. Recognizing this obstacle, CMS on May 1 changed the rules to allow billing for telephone and other audio-only telehealth visits.
The May 1 reforms also expanded the categories of providers allowed to provide telehealth services to patients. Before this reform, only doctors, nurse practitioners, physician assistants, and certain other individuals could provide telehealth services. Now, physical therapists, occupational therapist, and speech language pathologists also can bill for telehealth visits.
AMA Supported Change
The change was so well-received that after years of remaining neutral on telehealth, the American Medical Association (AMA) endorsed the idea, announced initially by CMS March 11.
In the run-up to those changes, the AMA on April 10 sent letters to the National Governors Association, the National Association of Insurance Commissioners, and the National Council of Insurance Commissioners to support policies encouraging telehealth and other innovations that improve patients’ access to doctors.
“The AMA strongly encourages all states to adopt telehealth policies that reflect those now being required under Medicare,” states one of the letters.
‘Ahead of the Game’
The suspension of regulations in a variety of areas during the coronavirus pandemic has been good public policy, says John Goodman, Ph.D., president and chief executive officer of the Goodman Institute for Public Policy Research and co-publisher of Health Care News.
“Governmental bodies are repealing laws, suspending regulations, and ignoring previous restrictions that impeded the ability of the private sector to act,” said Goodman. “They are liberating doctors, nurses, drug manufacturers, test makers, makers of personal protective equipment, etc. to do things that were illegal only a few months ago. Fortunately, the Trump administration was ahead of the game, making many needed changes before the COVID-19 virus hit. Once in crisis mode, Congress and state governments also responded, apparently in sheer desperation.”
‘Should Do More’
The changes are welcome, and Congress and the states should implement further reforms, says Marie Fishpaw, director of domestic policy studies at The Heritage Foundation.
“President Trump reiterated his commitment to clearing away barriers inhibiting the use of telehealth,” said Fishpaw. “Lawmakers have already moved to clear some away, but they can and should do more.”
There are still some important government-made barriers to telehealth, says Fishpaw.
“Among them are wide variations in the description of telemedicine among the states, with different definitions, regulations, and reimbursement arrangements,” said Fishpaw. “Only nine states have issued licenses related to telehealth that allow an out-of-state licensed medical professional to render services using telehealth.”
Great strides have been made in the increased use and acceptance of telehealth, and this should continue after the national emergency caused by COVID-19 ends, says Fishpaw.
“Absolutely, policymakers should build on the regulatory relief that the administration, Congress, and some states have done,” said Fishpaw. “This will help patients to access this care going forward and create an environment where innovators can develop new telehealth tools that we can’t even begin to imagine today. In addition, we not only need to make access to telemedicine permanent, but lawmakers should remove additional barriers that prevent patients from receiving timely and affordable care.”
Kelsey E. Hackem, J.D. (email@example.com) writes from the state of Washington.
The Centers for Medicare & Medicaid Services, Medicare Telemedicine Health Care Provider Fact Sheet, March 17, 2020: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet