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Pandemic helps to change telehealth policy -- slowly

Telehealth policy is changing, thanks to COVID-19, but providers worry some changes won't last.

Regulatory telehealth policy changes enacted by the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services during the COVID-19 pandemic have greatly impacted telehealth use among providers. Now, healthcare stakeholders want those changes to remain indefinitely.

Healthcare providers and other stakeholders argue that they've made significant investment in telehealth platforms to keep serving patients during the pandemic -- and that the use of telehealth to care for patients has worked. But if certain telehealth policy changes, such as increased reimbursement, aren't made permanent, healthcare systems won't be able to sustain their virtual care programs.

The kind of change that providers are calling for is happening -- but slowly.

CMS takes step toward permanent change

Last week, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would make a piece of telehealth policy changes enacted during the COVID-19 pandemic permanent.

If the proposed rule is approved, home health agencies such as nursing homes will be able to continue using telehealth to provide care to Medicare beneficiaries beyond the pandemic. Home health agencies will have to outline telehealth service in the patient's care plan and tie it to specific goals showing how that technology would play a part in treatment outcomes.

Arielle Trzcinski, Forrester analystArielle Trzcinski

Forrester Research analyst Arielle Trzcinski said, while the proposed rule is a step toward making changes permanent, it is "very specific" to home health agencies and is not all-inclusive of virtual care being delivered to Medicare patients across healthcare provider organizations. It also does not address making other changes permanent, such as allowing Medicare beneficiaries to receive telehealth treatment in their homes instead of traveling to a designated telehealth site. 

"It's maybe a toe-dip in the water of trying to make changes permanent," Trzcinski said. "Changes that, frankly, many providers have now become accustomed to, even though they are temporary. It's a new way of operating and physicians have had to transform their clinical workflows and the investments they've made in a number of different platforms and technologies just to be able to continue to drive revenue because so many of them have had to be closed."

On Monday, Michael Caputo, Health and Human Services (HHS) assistant secretary for public affairs, tweeted that the organization, of which CMS is a part, expects to extend its COVID-19 public health emergency declaration another 90 days, enabling providers to continue taking advantage of relaxed telehealth restrictions and policy changes.

To go back and move everything again would be incredibly disruptive and potentially pose risks to the continuity of care for patients.
Arielle TrzcinskiAnalyst, Forrester Research

Healthcare stakeholders argue that, not only do current telehealth policies need to be extended through the duration of the pandemic, but making certain changes permanent should be considered.

In a letter co-signed by the American College of Physicians, the American Medical Informatics Association, the College of Healthcare Information Management Executives and Premier Inc., a company that partners with healthcare systems, stakeholders urged HHS to continue implementing relaxed telehealth policies such as allowing providers to treat patients across state lines and use video conferencing tools like Skype and FaceTime without facing HIPAA penalties, noting that if the telehealth policy changes end abruptly, many providers won't be able to sustain telehealth use moving forward.

"Terminating the telehealth flexibilities prematurely could have a devastating impact on patients and clinicians alike," the letter stated. "The uncertainty surrounding whether the policy flexibilities enabled under the waivers will disappear is having a devastating impact already on our members and stoking fear." 

Providers weigh in

Edgar Chavez, M.D., CEO at the Universal Community Health Center in Los Angeles, said his biggest fear is that telehealth reimbursements, which have increased during the COVID-19 pandemic, will not continue when it's over.

Edgar Chavez, M.D., CEO, Universal Community Health CenterEdgar Chavez, M.D.

Prior to COVID-19, telehealth reimbursements for Medicare patients happened only when a patient living in a designated rural area traveled to a medical facility to receive telehealth treatment. During the pandemic, CMS began reimbursing providers for telehealth services offered to patients in their homes. CMS also expanded the types of telehealth services covered during the pandemic.

The Universal Community Health Center is one of thousands across the U.S. that had to rapidly scale a telehealth program to reach patients at home and enable a remote workforce during the pandemic. To sustain the organization's investments in telehealth, Chavez said he hopes federal and state regulators will continue working on reimbursement models for telehealth rather than revert to pre-COVID-19 policies.

"As soon as the emergency goes away, we are fearful that, no matter what we do, they're going to go back and they're going to say, 'You go back and you need to make it work,'" Chavez said during a recent virtual roundtable discussion hosted by healthcare tech vendor Luma Health. "So, what happens with all this money we invested into telehealth, into all these technologies that are allowing us to see patients in their home? It is a big, big worry that keeps me up at night."

Allowing providers to continue using telehealth platforms to treat Medicare patients in their homes is another worry, according to Medhavi Jogi, M.D., a practicing endocrinologist at Houston Thyroid and Endocrine Specialists.

Medhavi Jogi, M.D., endocrinologist, Houston Thyroid and Endocrine SpecialistsMedhavi Jogi, M.D.

"The changes I really liked are everything CMS did to get rid of provider site requirements," he said during the virtual roundtable, referring to the policy that states telehealth should connect one health organization to another -- not to a patient's home.

For Forrester's Trzcinski, increased reimbursement is one of the main telehealth policy changes that will make healthcare systems' investments in telehealth programs sustainable.

"To go back and move everything again would be incredibly disruptive and potentially pose risks to the continuity of care for patients," she said.

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