COVID-19’s Impact on Technology-Enabled Health Care
Use cases for telemedicine and health insurance.
One of the most visible examples of the pandemic is telemedicine, by far the most mature technology-driven approach to Health care. The declaration of a public health emergency (PHE) allows the Centers for Medicare & Medicaid Services (CMS) to make many changes to legal or regulatory requirements. Key flexibilities in telehealth include:
Eliminate geographic boundaries to deliver telemedicine. Previously, telemedicine was only available when patients were in rural areas.
Keep patients at home while receiving telehealth services. Before the pandemic, residency was not an allowed arrangement (for compensation).
About 150 new health care services have been added to the Telehealth Services List to allow reimbursement.
Allows Rural Health Clinics (RHCs) and Federally Licensed Health Centers (FQHCs) to be remote site providers, previously without setting permissions.
Authorization and reimbursement for audio-only communications, rather than the (compatible) audio-video format typically required for telemedicine.
In a December 2021 report, the Department of Health and Human Services found that Medicare-paid telehealth visits increased from 840,000 in 2019 to about 52.7 million in 2020. About 92% of those patients received home care through telehealth.
For CHRs and FQHCs licensed as “off-site” providers of telehealth services, telehealth visits totaled 9,000 in 2019, increasing to more than 830,000 in 2020. Telemedicine increased significantly in urban settings after local restrictions were lifted. Northeast and West consumption is the highest.
According to the report, the nearly 1 million weekly primary care telehealth visits in April 2020 dropped to less than half by October 2020. However, this was not the case for behavioral health professionals, who saw the largest overall increase in telehealth, accounting for nearly one-third of all visits. These visits have increased from 8,000 in January 2020 to 280,000 per week in May. This number averages 250,000 visits per week in 2020.
The second report looks at results from the Census Bureau’s Household Survey, which includes a broader population than Medicare, such as children and the uninsured. The report found that telemedicine (and audio-only communication) usage remains high in 2021: 23 percent of respondents said they had received telehealth in the past four weeks. However, telehealth use varies widely by factors such as income, education, race and ethnicity, and health insurance status. A second report provides more information on future considerations.
Congress can make permanent changes.
Patients have seen significantly higher levels of telehealth use during the pandemic, and providers have been quick to implement telehealth capabilities. However, once PHE is complete, Medicare will also be less flexible. Congress recognized this and extended various flexibilities to an additional 151 days after PHE (Omnibus Appropriations Act 2022).
Based on the experience of the pandemic and the effectiveness of telehealth, some members of Congress want to do more to advance telehealth. One of the bills promising possible action this fall is H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2022.
HR 4040 extends the following policies through 2024:
Eliminate geographic requirements to provide telehealth services only in rural areas.
Remove initial site restrictions so people can watch from home
Allowing more professionals to provide telehealth, such as physiotherapists
Allow CHR and FQHC to provide telehealth as remote site providers.
Audio-only (i.e., asynchronous) telemedicine is permitted.
Allows hospice face-to-face verification requirements to be met through telemedicine (person-related).
In-person mental health visit requirements postponed until January 1, 2025
Although HR 4040 does not provide a permanent extension of these policies, enactment of the legislation will allow more time to study how they affect care delivery and cost. Also, the extra time will give Congress a chance to approve the changes.
