On Thursday, August 6, Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS) and a member of the White House Coronavirus Task Force, convened a roundtable discussion with Boston-area health care leaders to discuss the effects the coronavirus disease 2019 (COVID-19) has had on care delivery, and the impact of telehealth on patient access to care. Massachusetts has had one of the highest rates of telemedicine use in the country, with nearly half of all Medicare fee-for-service (FFS) beneficiaries - approximately 430,000 out of 980,000 - receiving a telemedicine service since the start of the pandemic, compared to nearly one-third of Medicare FFS beneficiaries nationwide.
The roundtable opened with a discussion about the unprecedented expansion of Medicare telehealth that CMS has undertaken in the face of the pandemic, noting that earlier this week, President Donald Trump signed the Executive Order on Improving Rural and Telehealth Access that moved to make many of the new telehealth flexibilities provided during the COVID-19 public health emergency (PHE) permanent. Administrator Verma said the move represents a seismic shift, initiating a new era of healthcare delivery in America.
Representatives from American Well, Blue Cross Blue Shield of Massachusetts, Mass General Brigham, Massachusetts Health Data Consortium, Massachusetts Health & Hospital Association, Massachusetts Health Quality Partners, Needham Wellesley Family Medicine and UMass Memorial Health Care participated in the discussion, and shared their experiences and insights.
Participants described the innovative ways that providers are using telehealth, from ICU consults to help preserve personal protective equipment (PPE), to primary care providers maintaining access to care for their patients with chronic conditions, to expanded access to mental health services.
With CMS providing flexibilities for telehealth use early in the pandemic, participants were able to set up telehealth infrastructure quickly, and observed how telehealth can be used to develop a more resilient healthcare system in the midst of a pandemic. Participants also discussed how telehealth can play an important part in providing value-based care.
On August 3, CMS announced in the CY 2021 Physician Fee Schedule Proposed Rule that it is proposing changes to expand certain telehealth flexibilities permanently, consistent with the President’s Executive Order signed that day. The Executive Order and proposed rule advance CMS’s efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas.
The expansion of telehealth coverage is just one of the many ways that CMS has responded to the pandemic to ensure the safety and well-being of Medicare beneficiaries.
Below is a list of CMS actions taken to ensure Americans have access to broader telehealth services, ensuring access to care while reducing the risk of COVID-19 exposure for both patients and healthcare providers:
- Expanded telehealth coverage to people living in all areas of the country so that beneficiaries living in both rural and urban settings can get care from their home rather than unnecessarily traveling to their doctor’s office.
- Expanded the types of services patients can receive via telehealth, such as emergency department visits, initial nursing facility and discharge visits, home visits, critical care visits, radiation treatment management, therapeutic exercise, prosthetic training, assistive technology assessments, group psychotherapy, and end-stage renal disease care.
- Expanded Medicare payment for telehealth services to allow routine office visits, preventive health screenings, mental health counseling, and care that ordinarily would require a trip to an outpatient clinic or hospital emergency room to be provided wherever the patient is located, including in their home.
- Allowed telecommunications technologies to be used in lieu of in-person services across many settings of care, like home health, nursing homes, and hospice.
- Expanded the types of healthcare providers that can provide telehealth services to include rural health clinics, federally qualified health clinics, physical therapists, occupational therapists, and others.
- Expanded the scope of separately billable services that allow Medicare physicians to speak with patients virtually, by phone or video, rather than in person in order to prevent risk of infection.
- Added payment for services of physicians and practitioners who treat patients over the phone to meet the needs of Medicare beneficiaries who may not have access to interactive audio/video technology.
- Authorized Medicare Advantage plans to offer expanded telehealth coverage in urban and rural areas to meet the needs of their enrollees.
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