Dive Brief:

  • President Donald Trump late Monday signed an executive order directing the administration to permanently extend Medicare’s broader telehealth coverage after the public health emergency, and CMS followed by proposing a rule that does so — albeit on a piecemeal, service-by-service basis.
  • The proposed changes, in its 2021 physician fee schedule released Monday night, would allow Medicare providers to conduct evaluation and management (E/M) home visits for established patients virtually, allow an emergency room E/M virtual visit for minor to moderately severe health issues and expand some telehealth services similar to telehealth services already covered by Medicare, like for group psychotherapy or care for patients with cognitive impairment. Nine new telehealth codes will be permanent, and 13 will be covered through the calendar year in which the public health emergency ends, to give physicians a chance to deliver services virtually before CMS decides whether or not to permanently allow them.
  • Notable exclusions are payment for audio-only telehealth visits conducted over the telephone, though CMS noted consumer demand could remain as Medicare beneficiaries, of which an estimated 40% don’t have access to a computer with internet, look to receive care while avoiding potential infection. CMS asked for public input on any services it temporarily included for the scope of the emergency that it’s not proposing to cover permanently. Comments are due Oct. 5.

Dive Insight:

Telehealth utilization has skyrocketed since the administration broke down regulatory barriers to access and governors enacted widespread stay-at-home orders beginning in March, though there are some initial signs it began to plateau starting two months ago as states prematurely opened their economies.

In the week ended March 7, only 11,000 elderly and disabled Americans in Medicare used telehealth. By the week ended April 25, that had snowballed to 1.7 million Medicare beneficiaries.

The biggest question mark hanging over the industry is how many of the regulatory changes that spurred unprecedented adoption will remain post-COVID-19. Prior to Monday’s rule, CMS temporarily allowed more than 135 additional services through telehealth, and signaled it wanted to make many permanent beyond the scope of the public health emergency announced in March and renewed late July.

The agency started with permanently allowing the use of virtual care in home health late June, though it can’t be reimbursed as a visit.

The most meaningful changes would require congressional intervention. Lawmakers on both sides of the aisle have introduced a series of bills to expand telehealth availability, though it’s unclear what provisions if any will make it into a planned fifth round of COVID-19 relief.

Either way, the order and the proposal are a net positive for telehealth vendors like Teladoc, Amwell, Doctor on Demand and MDLive. The moves entrench the modality more firmly into the regulatory landscape, lessening the fear coverage for virtual care could disappear along with the national emergency.

In the physician fee schedule for 2021, CMS also proposed lowering the conversion factor used to calculate rates, which would reallocate Medicare dollars, benefiting general medicine at the expense of some specialists, Jefferies analysts said.

Rates for physical therapy, anesthesiology, nurse anesthetists and emergency medicine would fall 9%, 8%, 11% and 6%, respectively.

Surgeons would be particularly hard hit: If the proposed fee schedule is finalized, Medicare reimbursement would be cut by 9% for cardiac surgery, 8% for thoracic surgery, 6% for ophthalmology and 7% for vascular surgery, general surgery and neurosurgery.

The American College of Surgeons lashed out against the cuts… … to read the full article, please click HERE.

publish date: August 4, 2020 / author: Rebecca Pifer