Report Recommends Ways to Preserve Expanded Telehealth

CAST | August 17, 2020 | by Donna Childress

More telehealth opportunities increase access across age, race/ethnicity, income, and urbanicity and could decrease hospital admissions.

A new report recommends ways to preserve the expanded use of telehealth that has come from the COVID-19 public health emergency. “Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19” notes that the expanded telehealth policies, including audio as a reimbursable telehealth modality, have yielded similar rates of access regardless of age demographic, race/ethnicity, income level, and urbanicity.
 
To mitigate the concern that expanding virtual care could increase Medicare services and costs, the report said, the Centers for Medicare & Medicaid Services (CMS) could give clear guidance on payment, evidence-based clinical judgment, and quality measures. 

Improved access to telehealth could also increase access to preventive services and care management, decrease behavioral health “no-shows,” and decrease avoidable inpatient admissions.

Methods

To create the report, Better Medicare Alliance partnered with ATI Advisory (ATI) to interview 17 Medicare Advantage and telehealth stakeholders and analyzed 2017 Medicare Current Beneficiary Survey data to quantify community-based beneficiaries’ access to internet services.

Stakeholder Experiences

One-on-one interviews with plans and providers found that risk-bearing payment arrangements allowed them to act nimbly, meet evolving Medicare beneficiary needs, and facilitate telehealth implementation and expansion during the pandemic. Traditional FFS Medicare policies slowed the uptake of telehealth.
 
Several factors helped plans and providers to quickly expand telehealth services:

  • Flexibility under risk-based payment.
  • Allowing home-based telehealth.
  • Removing prior relationship requirements, so that Medicare recipients did not need to have an established relationship with the telehealth provider.
  • Expanding providers and services eligible for payment.

Barriers included traditional FFS Medicare prohibitions, interactions between Medicare and Medicaid, beneficiary device and data access, and rigidity of the benefit and bid submission process.

Beneficiary Experiences and Preferences

Plans and providers are seeing significant increases in telehealth and virtual care utilization, especially in accessing behavioral health services. One telemedicine vendor reported a 22-fold increase among its providers. A payer-provider (referred to as payvider) reported growth from 100 visits per week to 10,000 per week. Research found that 78% of seniors were likely to use telehealth again and that 91% of seniors had a favorable telehealth experience.
 
Regarding internet access, low-income Medicare beneficiaries are more likely than higher income beneficiaries to report no internet use, at 34% and 5%, respectively. Of Medicare beneficiaries in rural areas, only 38% use the internet several times per week or daily, compared with 57% of those in metro/urban areas.

Recommendations

The report recommends that CMS and Congress allow for continued flexibility in providing telehealth services to Medicare beneficiaries. The focus should be on improving access, process, and payment policies for telehealth services. Flexibility for Medicare Advantage plans and providers should be allowed, coupled with accountability that preserves and expands access to quality care. Recommendations include the following:

Access:

  • Update §1834(M) Provisions in the Social Security Act: Eliminate or expand originating site requirements, expand geographies to include all counties, and expand qualified distant site providers to include allied health professions, Federally Qualified Health Centers, and Rural Health Clinics. Allow for services to be reimbursable without a prior provider relationship.
  •  Virtual Health Modalities: Permanently expand services allowed through modalities such as audio-based and asynchronous technologies.

Process and Payment:

  • Medicare Advantage Bid Process: Consider the capacity for Medicare Advantage plans to innovate as providers build infrastructure for telehealth and as beneficiary demand for virtual services grows.
  • Update Medicare Fee-for-Service Schedules and Service Payment Models: CMS should modify Traditional FFS Medicare fee schedules to reflect growing telehealth and virtual care delivery, which ensures services are not reimbursed twice. Payment for telehealth should be on par with in-person services as appropriate.
  • Risk Adjustment: CMS should allow virtually informed risk adjustment with certain guardrails. 

For more information, see the full report. Please also review LeadingAge’s 2020 policy priorities on Telehealth and Technology, which are in line with the report’s recommendations.

CAST Telehealth and RPM Selection Tool

If you are considering implementing telehealth technologies at your organization, be sure to explore the LeadingAge CAST Telehealth and RPM Selection Tool. It includes a white paper, interactive guide, selection tool, selection matrix, and case studies that can help you to choose the technology that is best for your organization. Also, please check LeadingAge’s QuickCast on Telehealth, Telemedicine, and Remote Patient Monitoring, which CAST developed to help members during the COVID-19 crisis.

Telehealth Case Studies Featured at CCHIT Summit

Learn more about Telehealth Case Studies from the Trenches in response to COVID-19 and beyond at the Collaborative Care & Health IT Innovations Summit, to be held virtually Sept. 15-17, 2020.

LeadingAge CAST and the LTPAC Health IT Collaborative bring you this outstanding conference and hope you will register today.