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Submitted by admin on 11 June 2020
Saisystems Health Blog Telemedicine has grown substantially, but will the rules stick

Telemedicine has grown substantially, but will the rules stick?

Telemedicine claims have grown 4,347% comparing March 2020 to March of 2019, reports FAIR Health, Inc who have developed and published an online data tracking tool which presents regional and national comparative data.  https://www.fairhealth.org/states-by-the-numbers/telehealth

This unprecedented growth was only possible because the pandemic triggered several regulatory exceptions and rule changes made to improve access and reimbursement when providing patient care through telemedicine.

Healthcare providers, practices and institutions across the country have been able to quickly pivot their delivery models to implement and support the provision of care through telemedicine.

However, the current rule changes expire when the Federal government lifts the emergency period.  For the time, September 30, 2020 is the documented expiration date for many of these temporary changes.

As this date approaches, healthcare business leaders need to take action to influence the future of these rules if telemedicine is to remain in place as a meaningful part of the delivery of care in their organization.

In recent weeks state governments have begun to consider legislation that would require commercial health plans to continue to cover telemedicine services without significant restrictions or limitations.  Colorado and Rhode Island are both considering such bills that would support continued telemedicine services and would remove any in-person first visit requirement.

As the federal government addresses ongoing rule changes to support healthcare delivery during the pandemic, prominent voices have started to emerge voicing support for a continuation of the current rule structure.  

On May 26, 2020 thirty members of Congress drafted a letter to Congressional leadership to continue the current telehealth regulatory relaxations for a reasonable period after the emergency period ends to allow for the assessment and determination of rules that should be permanently changed.  On June 1, 2020 Representative Robin Kelly (D-Illinois) introduced a bill requiring the Department of Health and Human Services, which oversees CMS, to conduct a vast study of the effectiveness of telehealth and telemedicine while the current rules are in place.

The Federal Trade Commission, on May 29, 2020 sent a letter to CMS asking that the restrictions on telehealth services and reimbursement be lifted permanently.  The FTC remarks in their letter that the temporary expansion of telehealth has increased the supply of providers and improved patient access and choice.  They further go on to remind CMS that Medicare policies influence payment coverage and policy development within the Medicaid program as well as within commercial payors and in order to support “fulfilling telehealth’s potential” the reduction of these historical restrictions must be considered.  (Becker’s Hospital Review, 6/3/2020).

Finally, on June 8, 2020, Seema Varma, CMS Administrator is quoted in a STAT + conversation as saying, “I can’t imagine going back”, in reference to continuing the expanded coverage and payment for telemedicine services that have been allowed during the pandemic.  She further stats that government must determine if they can continue to reimburse for telemedicine visits at the same level as face to face visits.

Ultimately, permanent change to improve telemedicine access must come in the form of legislative change in the U.S. Congress, but in the meantime Administrator Varma shared that CMS is looking for ways to maintain patient access to services in certain settings and is also evaluating ways to broaden the depth of covered telemedicine services.  In her final comments, she remarks that the nation will also need to rethink provider licensing and look for effective solutions to providing care across state lines.  (STATnews.com 6/9/2020)

With this recent activity, there is growing interest to provide for continued expanded access to telemedicine as an effective means of delivering care.  It is imperative that healthcare leaders that are finding success with telemedicine voice their results to policy makers.

  • Contact your U.S. Senator and Representative and encourage their support of appropriate bills that may be introduced in Congress.
  • Likewise, contact your local state government representative to voice your support and encourage their support of appropriate bills at the state level.
  • Within the commercial health plan environment, voice your support for long term change through your provider representative, plan Medical Director or other senior level contact you may have.

Saisystems Health will continue to monitor and report on changes as they develop.  

If you have questions regarding telemedicine and its impact upon your practice contact us at info@saisystems.com