A series of changes in Medicare over the last month allowing health care providers to receive reimbursements for telemedicine services was something providers thought would take years.
Prior to the nation’s outbreak of coronavirus and the social distancing protocols that came with it, hospital systems in the region were already using video conferencing software between doctors and patients, referred to as telemedicine. But reimbursements from third party payers, particularly Medicare and Medicaid, were much less than they would be in an in-person doctor’s visit if they were reimbursed at all.
Providers and hospital systems could see the benefit of allowing their patients to stay home during a visit, but the lack of funding for telemedicine meant that it was generally reserved for patients with limited mobility or in rural regions with limited medical services.
In the past month, the health care industry has had to completely change how it looks at telemedicine after a string of regulatory rollbacks by the Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country.
To promote social distancing and to protect at-risk patients from contacting COVID-19, the agency introduced leniencies on HIPAA requirements to allow providers to use a variety of video software while conferencing with patients. It also opened the door to reimbursements of telemedicine that are much closer to what a provider would make during an in-person meeting.
“Prior to CMS’ update, you got paid nothing. Providers would only be paid a marginal amount if they were in what is considered a ‘medical wasteland,’” said Heather Modjesky, senior administrator and director of community outreach at Conestoga Eye, an ophthalmology practice in East Hempfield Township, Lancaster County.
CMS announced it would be broadening access to Medicare telehealth services on March 17 as a response to President Donald Trump’s national emergency declaration on March 13.
“Under this new waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6,” CMS wrote.
Both Penn State Health and UPMC Pinnacle have systems in place to connect patients with providers through video conferencing, but were not using it to the extent they can now.
“We have been providing telehealth to our ALS patients for a long time here,” said Dr. Chris DeFlitch, Penn State Health’s Chief Medical Information Officer. “Providing telehealth to that population so they can stay at home and still work with their physicians and specialists is a big deal.”
CMS’ regulation changes related to HIPAA compliance give more freedom to providers when it comes to the video conferencing they use in telehealth. For smaller providers, that means they can use apps like Facebook Messenger and Skype that wouldn’t have been compliant with HIPAA regulations before the change.
Hospital systems that already us their own HIPAA compliant software, can expand their telemedicine offerings using the systems already in place.
Within a week of increasing its focus on telemedicine, UPMC Pinnacle’s online ambulatory visits increased 820% and the system trained more than 650 ambulatory health providers and specialists to use its telehealth program, said Dr. Christian Caicedo, president of the Dauphin Region for UPMC Pinnacle
“I’ve been following telemedicine and supporting it for many years and I’ve seen the barriers to developing it,” Caicedo said. “I can tell you that once coronavirus is under control and we are back to business as usual, health care will not look like it did six weeks ago.”
While the uses for telemedicine have increased, some specialties benefit from the service more than others, with visual specialties like dermatology having more uses than specialties or check-ups that require physical exams.
For an ophthalmologist like Dr. David Silbert, of Conestoga Eye, telemedicine can be the default way he sees patients, with in-person meetings reserved for physical checkups such as when a patient has low eye pressure.
For providers, there is a learning curve when it comes to working with sight and sound, and doctors sometimes need to rely on creative ways to understand what a patient is feeling, said Caicedo.
“What the doctors are learning while doing this is, how do they gather the info via a video visit without being in the room,” he said. “How do you assess someone with belly pain without having to touch them? You can do things like asking them to stand and jump on one leg. Does that make your belly hurt?”
Bridging the digital divide
One problem that remains for providers and systems relying on telehealth is the number of patients who don’t have access to reliable internet or laptops, said Dr. Michael Seavers, program lead for Healthcare Informatics at Harrisburg University.
“We have to talk about the digital divide,” Seavers said. “Some of the population that needs telehealth the most doesn’t have access to it. We aren’t 100% that everyone has the ability to do telemedicine.”
Seavers and Nancy Mimm, an assistant professor of nursing at Harrisburg University, said that the increase in telemedicine could be a driving force in the U.S. making the internet a basic need and could increase governmental focus on improving rural health care.
The boom in telemedicine is currently a temporary one, according to CMS, which has stated that the rollbacks are directly related to the COVID-19 pandemic and are not permanent.
But many in the health care industry don’t think it will be that easy to roll back, noting that telemedicine can keep patients from catching other viruses while waiting in a doctor’s office, and save time and resources when traveling to a far off specialist.
“I don’t see it peeling back and since the public, government and payers have seen a potential benefit from it, I think they will start to insist upon it,” said Mimm.
Third-party payers such as Capital Blue Cross and Highmark BlueCross Blue Shield have also temporarily expanded their eligible telehealth services, which normally depend on the benefits someone has, in accordance with CMS’ waiver.
If CMS were to make the changes permanent, Seavers believes other insurers could also move to provide similar reimbursements for telehealth compared to in-person visits permanently.
“CMS creates a lot of red tape in some ways but also creates a lot of breaking down of barriers for reimbursements,” he said. “Here in central Pa., if Highmark starts doing something Medicare is doing and Capital isn’t, well guess what they will have the pressure to do it as well.”