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Telehealth in Medicare & Medicaid:

by | Oct 28, 2020 | 115, Doctor, Medicare, News, Telehealth | 0 comments

The Hidden Hero Keeping Us Connected to Our Doctors even in a Pandemic

“The genie is not going back in the bottle!”

In recent months, the Centers for Medicare and Medicaid Services (CMS) has expanded access to telehealth services under President Trump’s emergency declaration. This allows beneficiaries to receive a broader range of services from their doctors without going to a healthcare facility. These benefits are part of the larger effort put forth by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk – are aware and able to access systems that can keep them healthy. 

Under the 1135 waiver, Medicare can now pay for office and hospital visits – among other types of visits – furnished via telehealth across the country. This is a drastic change from before the waiver when Medicare could only pay for telehealth services on a limited basis.

As of October 14th, the CMS added eleven new services to the growing list of telehealth services that Medicare will reimburse during the COVID-19 public health emergency. Since March 2020, Medicare has added more than 135 services via telehealth that it will pay for, including emergency department visits and nursing facility visits. Seema Verma, the administrator of CMS, said of the additions: “Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country… This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let the genie go back into the bottle (CMS.gov, 2020).” 

In the past three years, CMS has been working to modernize Medicare as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives. It has unleashed innovation in the private sector, improving access to telecommunication technologies and services to beneficiaries. Starting in 2019, Medicare began paying for virtual check-ins where a patient can connect with doctors via phone or video chat. These check-ins were done as a preliminary way to assess whether the patient needed to come in for an in-person visit. However, in response to the COVID-19 pandemic, CMS rapidly expanded its payment for telehealth services. This allowed Medicare beneficiaries living in all parts of the country access to high-quality care from the comfort of their own home where they could avoid unnecessary exposure to the virus or other illnesses. 

“Before the COVID-19 pandemic, only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July” reports CMS.gov. 

Telehealth in Medicare: What does it look like? 

As the healthcare industry has had to rush to fill the gaps in coverage during the COVID-19 pandemic, CMS has made keeping people safe and avoiding unnecessary exposure to the virus a priority. Providing a fact sheet on the various telehealth services now allowed through Medicare, patients, and healthcare providers alike can seek guidance on the best options for personalized care. This historic effort has been made possible by new policies implemented in both 2019 and 2020. 

For a beneficiary, these services can look like an inquiry call to their doctor if they are experiencing symptoms. During this call, it can be assessed whether a physical exam is needed or merely remote monitoring to see if symptoms worsen. If the beneficiary worsens, a virtual check-in allows the doctor a chance to make recommendations without making a patient step into the office or hospital. 

Telehealth in Medicare: Here to stay?

Telehealth services and the technologies needed for such procedures are nothing new. They were already in progress and en route to being widely accepted before the start of this year and the COVID-19 public health emergency. However, due to the PHE, telehealth became the premier source of care – being widely accepted and, in many cases, the only avenue through which medical attention could be accessed. As we have no real way of knowing the PHE’s end, there is no approaching end date for telehealth and its services. Not to mention, with its proven track record thus far, it may very well become the preferred method of care for many patients. Medicare and Medicaid beneficiaries, especially. 

While telehealth will never replace the gold-standard of an in-person doctor’s visit, it serves as an important addition of access. Its rapid explosion in recent months has raised the question of whether returning to the status quo will turn back the clock on innovation and a new level of care. Remote patient monitoring (RPM) is one such innovation under question should Medicare revert to pre-pandemic telehealth service limitations. 

Telehealth in Medicare: What is RPM, and why is it the backbone of Telehealth?

Remote patient monitoring (RPM) is a delivery method for healthcare that uses the most advanced technologies to gather and analyze patient data, which is then used to develop and manage a treatment plan tailor-made or related to a chronic illness or health condition. RPM is about moving conventional healthcare delivery outside of the box for better patient care and outcomes. 

These technologies are the latest and greatest, emphasizing today’s consumer-friendly personal tech items. Leveraging Bluetooth and smartphones or tablets, these data collection devices are used specifically to make patients comfortable monitoring and aiding in their own care. As a result of this comfort, engagement levels between patients, their monitoring devices, and ultimately the doctor are increased. Naturally, higher engagement levels correlate to improving the overall quality of care. Not only is the patient incentivized to be involved in his or her own health due to the comfort of quality RPM devices, but clinicians are equally better equipped to understand and manage their patients’ health situations. This is extremely important in the prevention of deteriorating health or worsening conditions. 

RPM is the backbone of Telehealth because it enables clinicians to actually see what their patients are doing daily. Never before has this level of care been accessible to the public. As witnessed in recent months, without Telehealth – without RPM – the mode of most healthcare delivery systems would have been cut off for weeks on end. With Telehealth services and RPM, where a patient can interact with their doctor via technology and have their situations monitored 24/7, it is possible to diagnose, treat, assess, and prevent. It is more convenient than conventional doctor or hospital visits. It is more accessible to demographics of the public. And it is an essential part of limiting unnecessary exposure to the more vulnerable. 

In conclusion, without the advances of technology, especially in the medical field, the COVID-19 virus would be able to spread much faster and further like the H1N1 Influenza Pandemic of 1918 where social distancing wasn’t a thing between doctors and their patients nor even in medical wards. 50 Million people are estimated to have perished just a hundred years ago from a similar virus compared to the 1.14 million people who have died from COVID-19. No one should ever die from a horrible disease and our hearts go out to all those suffering from COVID-19 (it has touched our own office as well). It is our dream at Top Doctor Magazine and among the doctors we serve to continue the exponential growth in medical advances over the past century so that mankind can be much closer to realizing a world virtually free from life-ending diseases in the not-to-distant future.

Citations: 

Gilman, M., & Stensland, J. (2013). Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare & medicaid research review, 3(4), mmrr.003.04.a04. https://doi.org/10.5600/mmrr.003.04.a04 

CareInnovations. (2020). What Is Telehealth? What Is Remote Patient Monitoring? How Are They Different? Retrieved from https://news.careinnovations.com/blog/what-is-telehealth-what-is-remote-patient-monitoring-how-are-they-different 

CMS. (2020). President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak. Retrieved from https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak 

CMS. (2020). Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021. Retrieved from https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4

CMS. (2020). List of Telehealth Services. Retrieved from https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes 

Foley & Lardner, LLP. (2020). Top Ten Medicare Remote Patient Monitoring FAQs for 2021. Retrieved from https://www.foley.com/en/insights/publications/2020/08/ten-medicare-remote-patient-monitoring-faqs-2021 

CMS. (2020). Trump Administration Announces Historically Low Premiums and New Insulin Benefit as Medicare Open Enrollment Begins. Retrieved from https://www.cms.gov/newsroom/press-releases/trump-administration-announces-historically-low-premiums-and-new-insulin-benefit-medicare-open

CMS. (2020). Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak. Retrieved from https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak 

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