Prior to March 2020, only a small portion of care was provided via telehealth – often as a component of chronic disease management programs. At the time its growth seemed limited, because payers had traditionally been slow to develop reimbursement models for these virtual visits.
But the spread of COVID-19 changed this precedent in a matter of weeks. Indeed, the pandemic caused policymakers to suspend many administrative requirements inhibiting providers from offering telehealth services. These changes relating to clinician licensure, reimbursements, and the scope of eligible services catalyzed widespread telehealth adoption.
Regulatory changes
Following suit, the Centers for Medicare & Medicaid Services (CMS) announced changes to its reimbursement policy in March 2020 that allowed Medicare beneficiaries to access telehealth services while isolated at home. Previously, these benefits were only offered when care was provided in a rural setting that required the beneficiary to travel to a local, rural clinic.
CMS also began implementing permanent policies to increase access to some telehealth services beginning in 2021. To encourage provider participation, CMS made the following changes:
- Allowed reimbursement at the in-person visit rate for telehealth
- Permitted healthcare providers to reduce or waive cost-sharing for beneficiaries
- Allowed providers to deliver telehealth services across state lines
Specifically, providers can now conduct emergency department visits; initial inpatient and nursing facility visits; and discharge management services across state lines. Additionally, CMS also extended support for telehealth in both state Medicaid and Children’s Health Insurance Program (CHIP) initiatives to increase access for those beneficiaries.
Both the 2021 Physician Fee Schedule (PFS) Final Rule and the 2022 PFS Proposed Rule added more than 60 services to the Medicare telehealth list and set the stage for proposed legislation to permanently increase access to telehealth. Indeed, Congress is now reviewing proposed legislation that would abolish location-based restrictions for Medicare beneficiaries and expand the list of healthcare providers who could use telehealth covered by Medicare.
Finally, greater access to telehealth is expected as Congress moves on a large infrastructure bill which would include funding to expand broadband internet access to areas in the US that currently lack adequate coverage, such as rural America. This expansion will inevitably lead to greater demand for effective solutions to deliver high quality healthcare remotely.
Telehealth and data quality in healthcare
As this brief review shows, the shift in payment policy towards a more permanent adoption of telehealth services for a broader range of services and patients suggests that it is here to stay. This is in line with a broader push towards value-based care. Therefore, it is essential that data obtained and used via telehealth encounters is complete and accurate to evaluate outcomes and ensure proper use.
To learn more about the different applications of telehealth services – from acute care management to provider-to-provider consultations – download our latest eBook, Optimizing the use of telehealth through effective data integration and management, today.
