Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients

On December 1, the Centers for Medicare and Medicaid Services (CMS) released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule allows non-physician practitioners to provide the care they were trained and licensed to give, cutting red tape so health care professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. This final rule takes steps to further implement President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors including prioritizing the expansion of proven alternatives like telehealth.

“During the COVID-19 pandemic, actions by the Trump Administration have unleashed an explosion in telehealth innovation, and we’re now moving to make many of these changes permanent,” said HHS Secretary Alex Azar. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to health care in the setting that they and their doctor decide makes sense for them.”

“Telehealth has long been a priority for the Trump Administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck,” said CMS Administrator Seema Verma. “But the pandemic accentuated just how transformative it could be, and several months in, it’s clear that the health care system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in health care delivery.”

Finalizing Telehealth Expansion and Improving Rural Health

Before the COVID-19 Public Health Emergency (PHE), only 15,000 Fee-for-Service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services, such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that are covered by Medicare through the end of the PHE. These services were added to allow for safe access to important health care services during the PHE. As a result, preliminary data show that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service during the PHE.

This final rule delivers on the President’s recent Executive Order on Improving Rural Health and Telehealth Access by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE, and we will continue to gather more data and evaluate whether more services should be added in the future. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to health care.

Additionally, CMS is announcing a commissioned study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.

Payment for Office/Outpatient Evaluation and Management (E/M) and Comparable Visits

Last year, CMS finalized a historic increase in payment rates for office/outpatient face-to-face E/M visits that goes into effect in 2021. The Medicare population is increasing, with over 10,000 beneficiaries joining the program every day. Along with this growth in enrollment is increasing complexity of beneficiary health care needs, with more than two-thirds of Medicare beneficiaries having two or more chronic conditions. Increasing the payment rate of E/M office visits recognizes this demand and ensures clinicians are paid appropriately for the time they spend on coordinating care for patients, especially those with chronic conditions. These payment increases, informed by recommendations from the American Medical Association (AMA), support clinicians who provide crucial care for patients with dementia or manage transitions between the hospital, nursing facilities, and home. 

Under this final rule, CMS continues to prioritize this investment in primary care and chronic disease management by similarly increasing the value of many services that are similar to E/M office visits, such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services. These adjustments ensure CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients.

“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Administrator Verma added. “In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.”

In addition to the increase in payment for E/M office visits, simplified coding and documentation changes for Medicare billing for these visits will go into effect beginning January 1, 2021. The changes modernize documentation and coding guidelines developed in the 1990s, and come after extensive stakeholder collaboration with the AMA and others. These changes will significantly reduce the burden of documentation for all clinicians, giving them greater discretion to choose the visit level based on either guidelines for medical decision-making (the process by which a clinician formulates a course of treatment based on a patient’s information, i.e., through performing a physical exam, reviewing history, conducting tests, etc.) or time dedicated with patients. These changes are expected to save clinicians 2.3 million hours per year in administrative burden so that clinicians can spend more time with their patients.

Professional Scope of Practice and Supervision

As part of the Patients Over Paperwork Initiative, the Trump Administration is cutting red tape so that health care professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. The PFS final rule makes permanent several workforce flexibilities provided during the COVID-19 PHE that allow non-physician practitioners to provide the care they were trained and licensed to give, without imposing additional restrictions by the Medicare program.

Specifically, CMS is finalizing the following changes:

  • Certain non-physician practitioners, such as nurse practitioners and physician assistants, can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.
  • Physical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.
  • Physical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.

For More Information:

FHIR®-Up Your Electronic Health Records to Help Manage the Spread

The eCR Now initiative and the Association of Public Health Laboratories call on health care organizations to implement electronic case reporting (eCR) for COVID-19 and other diseases. Public health agencies need more timely and complete data. Hospitals, health care systems, ambulatory practices, and their partners can increase the implementation of eCR through participation in the eCR Now COVID-19 Challenge.

The challenge will increase the number of electronic health records (EHRs) enabled with eCR capabilities by use of the eCR Now FHIR® App and the HL7 FHIR® standard. The app enables eCR, helps meet legal reporting requirements, fulfills CMS’ Promoting Interoperability Program requirements, and moves public health in our nation forward.

The eCR Now COVID-19 Challenge will make up to three awards of $100,000 and three awards of $60,000 to eligible participants that accomplish production eCR for COVID-19 using the eCR Now FHIR® App.

Find out more about the challenge and pose questions to eCR public health and technical experts at these upcoming webinars:

Thursday, November 19
12:00-1:00 p.m. CT

Tuesday, December 1
12:00-1:00 p.m. CT

Webinar details are available on the eCR Now COVID-19 Challenge webpage.

States Turn to Telehealth During the Pandemic

Since March, 36 states, the District of Columbia and Puerto Rico have enacted more than 79 bills changing telehealth policies, either permanently or temporarily, during the pandemic. This article published by the National Conference of State Legislatures discusses the details of that legislation. The article was funded through HRSA’s cooperative agreement with the National Organizations of State and Local Officials.

Read the article.

Recent CMS Releases Related to Telehealth and COVID-19

CMS released a preliminary report providing Medicaid and CHIP data on telehealth use during the COVID-19 public health emergency through June 30. It provides a snapshot of services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June across various states and age groups, noting the significant increase in telehealth services compared to the same period last year.

CMS also released a supplement to its State Medicaid & CHIP Telehealth Toolkit to help states navigate telehealth service delivery and reimbursement. The supplement’s updated FAQs include resources states may consider for Federally Qualified Health Centers (FQHCs), specifically financing flexibilities in response to the pandemic. Visit CMS’ COVID-19 page for additional resources.

Recorded Webinar: Telehealth and COVID-19

WATCH NOW

The Health Resources and Services Administration (HRSA) invites you to view the updated recorded session on Telehealth and COVID-19The content has been updated to reflect recent changes in telehealth policies as well as the Telehealth Centers of Excellence and Avera’s current successes in delivering health care through the use of technology.

Learning Topics:

  • Review current telehealth policies under COVID-19
  • Discuss successful telehealth approaches/models to address the unique challenges in health care delivery during the COVID-19 pandemic (e.g., Virtual Screenings and Consultations, Remote Patient Monitoring, Tele-Emergency, Tele-ICU)
  • Highlight technical resources to assist in the development and expansion of telehealth programs

Featured Speakers:

  • Mei Kwong, JD, Executive Director, Center for Connected Health Policy
  • Dee W. Ford, MD, MSCR, Professor, Pulmonary and Critical Care Medicine, Medical University of South Carolina Project Director, Telehealth Center of Excellence Medical Director, Tele-ICU & ICU Innovations
  • Richard L. Summers, MD, FACEP Associate Vice Chancellor for Research, University of Mississippi Medical Center, Billy S. Guyton Distinguished Professor, Professor and Chair Emeritus Department of Emergency Medicine, Previous Lead Scientist for NASA Digital Astronaut Project
  • Brian S. Skow, MD MBA CPE FACEP, Chief Medical Officer, Avera eCARE

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute and Health Resources and Services Administration. PeerPoint Medical Education Institute is accredited by the ACCME to provide continuing medical education for physicians.

PeerPoint Medical Education Institute designates the enduring material format for this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

To access archived sessions of the telehealth learning series, click on the links below. 

For more telehealth resources and tools, visit https://www.hrsa.gov/rural-health/telehealth/index.html and https://telehealth.hhs.gov/.     

Telehealth for Formerly Homeless and Vulnerable Populations in Supportive Housing Fact Sheets

Social distancing protocols have elevated use of telehealth, which can be challenging for formerly homeless and vulnerable populations in supportive housing. The Corporation for Supportive Housing (CSH), a HRSA-funded NTTAP, created fact sheets to support health centers and supportive housing providers working in partnership to provide health and case management services through telehealth.

$5000 Grants Available for Rural Pediatric Clinics to Begin Telehealth

Application Deadline October 22

The “Supporting Providers and Families to Access Telehealth and Distant Care Services for Pediatric Care” project is a grant between the American Academy of Pediatrics (AAP) and the Maternal and Child Health Bureau (MCHB) in the Health Resources and Services Administration (HRSA). The goal of this grant is to support telehealth access and infrastructure for the provision of comprehensive care to children and adolescents, including children and youth with special health care needs (CYSHCN) and other vulnerable pediatric populations, utilizing a medical home approach during and after the COVID-19 pandemic. Read More

Expanded List of Telehealth Services

October 15, 2020

Yesterday, Centers for Medicare and Medicaid Services (CMS) notified Congress that they have, “Released an expanded list of telehealth services that Medicare will pay for during the COVID-19 public health emergency (PHE). Effective immediately, Medicare will begin paying eligible practitioners for 11 additional services delivered via telehealth, including certain cardiac rehabilitation and monitoring services.”

Information on newly added Medicare telehealth services and codes is available here.

Missouri Foundation for Health Webinar: Impacts of COVID-19 on Telehealth in Missouri

Date: October 22, 2020

Time: 2:00 PM Central

REGISTER

In this webinar, speakers will discuss opportunities and challenges facing the adoption of telehealth, during and after the pandemic, from a policy and health provider perspective.

Telehealth has long been available as a supplement to in-person care, though usage was low due to regulatory restrictions and infrastructure barriers. However, due to the need for virtual care during the public health emergency, regulations were relaxed allowing telehealth to quickly emerge as a viable alternative to traditional care.

As we continue to navigate existing challenges to widespread adoption of telehealth, the pandemic provides us an opportunity to think innovatively about how to transform current telehealth policy to ensure everyone has access to the care they need.

Read the Missouri Foundation for Health policy brief, “Navigating COVID-19: Health Policy Solutions- Telehealth,” for a summary before the webinar.