When I was a practicing physician, I balked at the idea of telehealth. That was long before the technology got so good and long before the COVID pandemic. How could a visit be helpful if I could not lay hands on my patient to examine them? If I could not hold their hand if they needed support? It did not make sense to me to put a physical barrier between the patient and their healthcare provider. Now I see that telehealth does the exact opposite. It doesn’t build walls; it breaks them down. It is a staple of health care we should protect at all costs.

What Telehealth Can Do

While certain situations warrant an in-person visit, many other office visits can be performed successfully using telehealth. You can review lab work with your doctor, talk about medical concerns, address mental health issues, and discuss various treatment options.

Your provider can walk you through the steps to count your pulse. Alternatively, if you are fortunate enough to have a smart phone or an exercise tracker like a Fitbit or Apple watch, etc., your device can do the work for you. Some people even have their own blood pressure cuffs and pulse oximeters (devices you put on your finger to check your oxygen level) to monitor other vital signs.

With proper lighting, your provider can do a visual exam. Are you pale? In distress? Having a hard time breathing? They can count how many breaths you take each minute and can listen for audible wheezing. You can even show rashes on camera. My point — there’s more you can do than you may realize.

OTHER BENEFITS
– Telehealth is convenient for patients who do not have reliable transportation.
– It helps people who struggle to get time off work for their routine medical visits.
– It often costs less than an in-person visit.

Before The Pandemic

Medicare telehealth coverage was very limited before 2020. For people on Original Medicare (Part A and Part B), you could only use the services if you lived in a rural area and were receiving care in one of the following locations.

• A community health center
• A critical access hospital
• A doctor’s office
• A federally qualified health center
• A hospital
• A hospital-based or critical access hospital-based dialysis facility
• A rural health clinic
• A skilled nursing facility (e.g., nursing home)

KEY POINT
You could NOT get telehealth from home!

The Bipartisan Budget Act of 2018 expanded telehealth services so that anyone on Medicare could get checked for a stroke (referred to as telestroke services), no matter where they were located. It also allowed people on home dialysis to use telehealth from home as long as they had an in-person visit with their medical provider at least once a month during the first three months of their home dialysis treatment and then at least once every three months.

Let’s not forget that Medicare Advantage plans offer everything that Original Medicare does, including the services from the locations listed above. In 2019, the Centers for Medicare and Medicaid Services finalized a ruling that allowed these plans to add even more telehealth services as a supplemental benefit. The new benefits, ironically, would not start until 2020, the year COVID took over.

During the Pandemic

COVID spread and lockdowns followed. People flooded hospitals and medical centers, afraid they were infected (and too often they were right). Other people avoided medical settings, afraid to get infected. That did not mean they did not need care. It was not as if their cancer or diabetes went away.

Telehealth was a safe way to make sure that essential medical care did not go to the wayside. That’s why the Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded telehealth coverage during the national public health emergency (PHE). It lifted the location requirements for Medicare, allowed care by out-of-state Medicare physicians, expanded services to more medical providers (audiologists, psychologists, physical therapists, occupational therapists, speech-language pathologists, and social workers), and increased the number of services covered by telehealth.

It helped that the CARES Act also changed how you could use these benefits. Telehealth is traditionally interactive audio-visual conferencing that requires that you and your medical provider both hear and see each other. It also required HIPAA compliant software to protect your health information. During the PHE, you could use audio-only visits, i.e., simple phone calls (no video), and there was flexibility as to what software could be used for video visits, i.e., Facetime, Skype, Zoom, etc.

As many as 9 million people on Original Medicare used telehealth from March to June 2020. That’s about 750,000 people per week. Compare that to 13,000 people per week in 2019.

DOES YOUR DOCTOR USE TELEHEALTH?
Not all offices offered telehealth before the pandemic. There are many reasons for that.
1) It costs to set up the needed HIPAA-complaint software and any licensing requirements for that software. It was easy (and free, in most cases) to use during the PHE. Not all offices may be willing to make the investment now that the PHE is over.
2) Medicare generally paid healthcare providers much less for these visits. During the PHE, Medicare made a point to pay providers the same rate as an in-person visit. This gave them an incentive to offer the service. Medicare is now considering going back to the pre-pandemic payment rates. Unfortunately, this could lead to fewer providers offering the service.

After the Pandemic

The PHE ended on May 11, 2023. That has implications for telehealth. Generally speaking, most of the expanded benefits you enjoyed during the pandemic will continue through December 31, 2024. The major difference is your provider must use HIPAA-complaint software again.

After December 31, 2024, many Medicare telehealth services will revert to prepandemic rules. Geographic restrictions will be back in play (you must be in a rural area at a designated location), audio-only visits will no longer be allowed, and only Medicare providers covered prior to the pandemic will be covered going forward. There is one exception — telehealth visits for behavioral or mental health care can still be audio-only and can still be done from home even if you do not live in a rural area.

Medicare Advantage plans can continue to offer telehealth services as a supplemental benefit no matter where you are located.

BE PROACTIVE
COVID opened everyone’s eyes to the possibilities of telehealth. If you believe you could benefit from these services, do not hesitate to reach out to your doctor. Find out what they offer.

CARES Act: AMA COVID-19 pandemic telehealth fact sheet. (2020). American Medical Association. https://www.ama-assn.org/delivering-care/public-health/cares-act-ama-covid-19-pandemic-telehealth-fact-sheet

CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage. (2019). Centers for Medicare and Medicaid Services. https://www.cms.gov/newsroom/press-releases/cms-finalizes-policies-bring-innovative-telehealth-benefit-medicare-advantage

Early Impact Of CMS Expansion Of Medicare Telehealth During COVID-19. (2023). Health Affairs Forefront. https://www.healthaffairs.org/content/forefront/early-impact-cms-expansion-medicare-telehealth-during-covid-19

H.R.1892 – 115th Congress (2017-2018): Bipartisan Budget Act of 2018. (2017). Congress.gov. https://www.congress.gov/bill/115th-congress/house-bill/1892

June 2023 Report to the Congress: Medicare and the Health Care Delivery System. (2023). MedPAC. https://www.medpac.gov/document/june-2023-report-to-the-congress-medicare-and-the-health-care-delivery-system/

‌Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List. (2018). Centers for Medicare and Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11063.pdf

Telehealth policy changes after the COVID-19 public health emergency. (2023). Department of Health and Human Services. https://telehealth.hhs.gov/providers/telehealth-policy/policy-changes-after-the-covid-19-public-health-emergency