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COVID-19 could be a watershed moment for telehealth policy

Stakeholders are calling on the Centers for Medicare and Medicaid Services to make telehealth policy changes permanent.

Healthcare stakeholders are calling for telehealth policy changes made during the COVID-19 pandemic to remain even after the pandemic ends.

Since March, federal organizations such as the U.S. Department of Health and Human Services (HHS) have taken steps to provide patients access to healthcare without having to leave their homes. Efforts were considered temporary and include expanding telehealth service coverage, waiving HIPAA penalties for using commercial video conferencing technologies, and provisioning millions of dollars to healthcare systems for expanding telehealth services.

Now, as regulators consider how to move forward after the pandemic, stakeholders such as the College of Healthcare Information Management Executives (CHIME) are asking that some temporary telehealth policy changes specifically from the Centers for Medicare & Medicaid Services (CMS) be made permanent.

Changes to telehealth policy

John Kravitz, CIO at Geisinger Health System in Danville, Penn., and chairman of the CHIME board of trustees, said before COVID-19, Geisinger offered telemedicine services in a limited capacity. Widescale adoption at Geisinger, as with other healthcare systems, was challenging because insurance coverage for telehealth services wasn't widely supported.

When COVID-19 hit and patients were asked to stay home as much as possible, telehealth use at Geisinger saw a dramatic increase, according to Kravitz.

Kravitz said what helped Geisinger scale up its telehealth services were telehealth policy changes handed down by departments within HHSincluding CMS. Federal regulators saw an opportunity for patients to continue getting treatment while adhering to state mandates to stay home, thus relaxing certain restrictions, such as CMS allowing clinicians to provide telehealth services to Medicare patients in states where they are not licensed. They also made it easier for healthcare organizations to receive reimbursement for telehealth treatments.

Geisinger Health System CIO John KravitzJohn Kravitz

Before the pandemic, Geisinger conducted 1,000 telemedicine visits a month. Now, the organization conducts 2,000 per day, Kravitz said.

"We're hopeful that this is being supported as the new normal -- to [provide] this kind of service for our patients and continue to get compensated for it," Kravitz said. "We've seen good, positive outcomes [and] great response to this by the providers. And, more importantly, patients are willing to do it."

Kravitz's position led him to co-write a letter with CHIME president and CEO Russell Branzell to CMS Administrator Seema Verma. In their letter, they stressed the need for making the temporary telehealth policy changes by CMS long-standing. The letter was submitted to CMS in response to two interim rules the organization published that addressed regulatory and policy changes made because of the pandemic, including telehealth policies.

"The increased use of telehealth has moved the country further into 21st Century medicine," the letter states. "The flexibilities are reducing burdens on providers and patients alike and reverting to pre-COVID telehealth policies will be seen as a step backward."

One telehealth policy change CHIME supported was to do away with Medicare's originating site policy. Under typical Medicare policy, a patient who receives a telehealth visit must participate in the visit at what's considered a "telehealth originating site," often a medical facility in a rural area. Rather than connecting a patient from their homes to a provider, the goal of the policy was to connect patients at smaller medical facilities with larger facilities or specialists.

CHIME "strongly supports" doing away with the originating site requirements and asked that a more flexible, permanent policy be established allowing Medicare patients to be treated via telehealth no matter the location.

Buchanan Ingersoll & Rooney attorney Heather Alleva Heather Alleva

Heather Alleva, an attorney specializing in federal healthcare regulation at Buchanan Ingersoll & Rooney PC in Philadelphia, said one of the most impactful waivers CMS instituted was the originating site telehealth policy waiver.

"Not only in the past has a patient needed to be located in a particular geographic area, limited to rural areas or outside of metropolitan areas, but they also had to be located in a particular type of medical setting," Alleva said. "Originating site waivers have made a really big shift in that."

Although stakeholders are advocating for some of the telehealth policy changes to remain permanent, CMS and other federal regulators, as well as insurance companies, are using the pandemic to test the viability of expanded services such as telehealth, according to Alleva. What policy changes become permanent will likely result from demand for services, she said.

The road ahead

Alleva believes how the future of telemedicine will unfold is unclear. On the one hand, outpatient and non-emergency services are beginning to reopen, and patients will likely revert to traditional types of care, lowering the demand for telehealth services, she said.

I think we would be making a big mistake to go back; I really feel that strongly.
John KravitzCIO, Geisinger Health System

On the other hand, Medicare patients who have benefited from telehealth services, such as elderly patients who can no longer drive to appointments, will push the demand for continued services post-pandemic.

"Telemedicine will be in greater demand among people who have really benefited from it," she said. "I think that's the reason you're seeing funding; people are seeing there are access points to care that can be delivered via telehealth."

Forrester analyst Arielle Trzcinski Arielle Trzcinski

Forrester Research analyst Arielle Trzcinski said during the peak of the pandemic in March and April, telehealth service vendors saw mostly COVID-19-related visits. Now, vendors are seeing a "big shift" toward general, routine care and chronic care management, which will likely play a role in decisions about telehealth policies moving forward.

"We're seeing people turn to virtual care for those types of reasons more frequently now," Trzcinski said. "If anything, this past month of May and [into] June will continue to be a pivotal moment to watch and see how people are changing their behavior and starting to turn toward virtual care first versus going in-person to a clinic."

Geisinger's Kravitz said the telehealth policy changes have been monumental in advancing adoption of telehealth services and that telemedicine is "the future" of healthcare.

"I think we would be making a big mistake to go back; I really feel that strongly," Kravitz said. "People are finally saying this technology really works and we can really utilize it, so why wouldn't we?"

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