In the space of a few short weeks, the health care field saw changes in Medicare that had been on the “wish list” for decades. Telehealth services are suddenly a benefit for every Medicare beneficiary.
The changes include the temporarily increased access through the Medicare 1135 waiver, which covers all office visits provided via telehealth in any setting throughout the country, for any physical or mental health service, and does not enforce the “established-relationship” requirement. In addition, the Centers for Medicare and Medicaid Services (CMS) added 85 more physician procedure codes to the list of Medicare fee-for-service (FFS) encounters that can be delivered via telehealth during the coronavirus pandemic emergency, raising the total number of Medicare FFS telehealth procedure codes to 191 (up from 106), which represents about 33% of all physician procedure codes. All provider organizations that are eligible to bill Medicare for their professional services can now deliver telehealth (see COVID-19 Emergency Declaration Blanket Waivers For Health Care Provider Organizations). We have created an update on all the new Medicare telehealth rules, services, and rates in our newest Market Intelligence Report, Medicare COVID-19 Telehealth Rules, Regulations & Rates.
As a result, virtual visits to a health care professional are on track to overwhelm all original expectations—from 36 million visits to 200 million visits a year, and from 10,000 visits a week to 300,000 visits a week (see Telehealth—Be Careful What You Wish For…). Specifically, the number of Medicare visits using telehealth has been estimated to have increased from 11,000 a week to 650,000 a week (see Home Health Industry ‘Getting Closer’ To Reimbursement For Telehealth Visits).
But telehealth is not a panacea for consumers or for provider organizations. For consumers, the common issues include a lack of access to broadband internet or low digital literacy (see Telehealth—Not For Everyone), as well as consumers with paranoia, resistance to change, and anxiety disorders. For provider organizations, there are also challenges. The anecdotal reports are that telehealth visits are shorter, leading to less revenue, and reports are starting to come in that some provider organizations are billing only to see the bills either turned down or only partially reimbursed (see Doctors Struggle To Get Paid For Telehealth Visits).
For more on the obstacles some provider organizations are having, I reached out to some of my OPEN MINDS colleagues. OPEN MINDS Senior Associate Sharon Hicks explained that the biggest barriers she has encountered are tech related, like “setting up billing systems, assuring the security of connectivity to electronic health records, and assuring the availability of an encrypted connection for the tele-session.” Her advice? Ms. Hicks advises that executives reach out to payers and see if they can set up some type of alternative payment arrangement to “get them over the hump” until the new, updated billing infrastructures are in place.
OPEN MINDS Senior Associate George Braunstein added that some professionals are having trouble adjusting their working style to fit the new telehealth medium, while many rural (i.e., remote) provider organizations are still struggling with the “simple” things like adequate WiFi service. And OPEN MINDS Senior Associate Lori M. Schmidt addressed the working style challenge by advising management to invest in a minimum of “basic support on the how-to’s of telehealth”—including training on lighting, camera angles, speaking, looking at the camera and not the monitor, etc. Base policies that are in place and work will allow executives to improve on the product and build their success.
The big questions are—will this situation remain when the pandemic crisis is over? Will services delivered through telehealth remain a benefit for all Medicare beneficiaries? There is growing support from provider organizations and advocates to keep the benefit (see Telemedicine Key To US Health Care Even After Pandemic Ends). And recent comments from Seema Verma, administrator for CMS, bodes well for continuation of these new rules. In a recent interview 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” (see ‘The Genie’s Out Of The Bottle On This One’: Seema Verma Hints At The Future Of Telehealth For CMS Beneficiaries).
But managers of provider organizations shouldn’t start counting their many visits (and new revenue streams) yet. Actuaries have long been concerned about overbilling of telehealth-delivered services—and case rates or bundled payments are a likely mechanism to be adopted to address that concern.
If the market activity is any indication, many health and human service executives expect Medicare telehealth to continue. Most recent, Doctor on Demand announced they are expanding their telehealth services to Medicare Part B beneficiaries (see Doctor On Demand Medical Care Available To 33 Million Medicare Part B Beneficiaries). Medicare Part B covers outpatient services for Americans over the age of 65. As part of their launch, the company announced it would waive copayments for all services provided for these customers during the pandemic crisis, including chronic disease management and prescription refills. Charles Jones, chief executive officer of MDLIVE, says his company is planning to expand into the Medicare Part B market after the company completes its assessment of the legal requirements (see Telemedicine Company Doctor On Demand Bets On Coronavirus Changes With Big Medicare Push). And, United Healthcare, a large insurer of Medicare beneficiaries, recently announced the $470 million purchase of AbleTo by its subsidiary Optum (see Optum Reportedly Finalizing $470M Purchase Of Virtual Behavioral Care Company AbleTo).
Assuming these changes in Medicare benefits remain, Medicare represents a new market for specialty provider organizations that are expanding their telehealth delivery systems. For a deep dive into Medicare telehealth, our new market intelligence report, Medicare COVID-19 Telehealth Rules, Regulations & Rates, provides information on the new benefit rules and rates. For even more on the current and future use of virtual care, check out these resources in The OPEN MINDS Industry Library:
- Telehealth—Not For Everyone
- Evidence-Based Telehealth Practice In The Time Of COVID-19
- 85 Codes Added To Medicare FFS Telehealth Reimbursement With Temporary COVID-19 Guidance
- CMS Expands Access To Telehealth Services During COVID-19, Raises Audio-Only Rates
- Telehealth—Be Careful What You Wish For…
- Telehealth: The Devil Is In The Details
- You Operate Virtually, You Serve Virtually, But Are You Marketing Virtually?
- No Easy Move! How’s That Virtual Operation Working For You?
- Ready Or Not, Going Virtual
- Go Virtual To Keep Your Consumers (& Your Revenue) – Resources You Can Use
And during the first week in June, if you are an OPEN MINDS Circle member, you can join us live on-line (at no additional fee) for the session, “The Convergence Of Technology & Crisis Management: Lessons Learned While Responding To A Pandemic & Planning What Your Organization Should Be Doing Right Now” at The 2020 OPEN MINDS Virtual Strategy & Innovation Institute, June 1–5, 2020. If you can’t join us live, registration will allow you to download session recordings and briefing presentations during and after the institute.