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Reimbursement for Remote Patient Care During the Pandemic
By Virginia Gleason

The worldwide COVID-19 coronavirus outbreak has brought to light opportunities for technology to aid in disease management and the containment of infectious diseases. Telehealth waivers have been issued under the Public Health Emergency declaration, but it is questionable whether this will change the health care environment long term.

On March 6, the President signed into law the Telehealth Services During Certain Emergency Periods Act of 2020, which was followed by the Coronavirus Aid, Relief, and Economic Security Act on March 27. These laws give the Secretary of the Department of Health and Human Services broad authority to lift existing restrictions on Medicare coverage and payment for telehealth services furnished to Medicare beneficiaries. To date, the restrictions lifted are long-needed changes that clear the way for the most at-risk and clinically vulnerable patients to receive care in their homes, which includes those who reside in nursing homes and assisted living facilities.

The care provided via telehealth can relate to any condition, not just those involving COVID-19. However, telehealth services can also be utilized for initial evaluations to determine whether COVID-19 testing is necessary. These changes mean patients without COVID-19 symptoms do not have to go to a physician’s office and be exposed to ill patients in order to receive ongoing health care treatment. A patient can see a physician using telehealth technology while remaining in their home as part of nationwide shelter-in-place recommendations.

This not only eliminates exposure to illnesses and disease spread but also helps patients who struggle with getting to the doctor’s office from a mobility and transportation standpoint. Getting to a physician’s office can be a barrier for patients living independently or under the care of family.

Long-Awaited Upgrades
There are several waivers issued by the Secretary that have been needed for many years in order for Medicare reimbursement to not only keep pace with technology changes but also improve access to care for Medicare beneficiaries. The key changes include the following:

• Telehealth Geographic Restrictions Waived. Telemedicine services can be provided at any location within the emergency area during the emergency period. Prior to the waivers, Medicare could pay for telehealth only when the person receiving the service was in a designated rural area.

• Originating Site Can Be the Patient’s Home. Patients now have access to telehealth services from more places—the most important being their home. Previous limitations required the patients travel to one of eight facility-based locations in order to obtain telehealth services from a distant-site provider.

• Telemedicine Services Can Be Provided via a Smartphone. If the device being used for the visit includes audio and video capabilities that can be used for two-way, real-time interactive communication, Medicare is now allowed to reimburse for that virtual visit.

Prior to the public health emergency, Medicare telehealth services were under strict restrictions. Patients had to reside in a rural area, were required to be physically present at a health care facility when services were provided, could obtain a limited list of approved telehealth services, and were required to use specific telecommunications and technology. Now, physician, emergency, and hospice visits, nursing facility admit and discharge visits, and therapy services are all covered under Medicare and are considered “types” of telehealth visits.

Additional Welcome News
As part of the expansion of telehealth coverage during the public health emergency, the Centers for Medicare & Medicaid Services has expanded the availability of other technology-based services that are covered by Medicare. These virtual services include the following:

• virtual check-ins, a five- to 10-minute check-in with a provider on the phone or an approved telecommunication device;

• e-visits, consisting of brief communication with a provider; and

• remote patient monitoring, the use of digital technology to collect health data and electronically transmit the information to health care providers.

The waivers issued by the Secretary make these types of virtual visits available to new patients in addition to established patients for whom these services were available before and will continue to be available after the public health emergency.

In addition to being available to new patients, remote patient monitoring can be provided for both acute and chronic conditions. In addition, remote patient monitoring is allowed for patients with only one disease, including if it’s acute. For example, the technology can be used to monitor a patient’s oxygen saturation levels using pulse oximetry from home.

There are many benefits to utilizing remote patient monitoring during the COVID-19 pandemic, including the following:

• the ability to monitor pulmonary functions, temperature, blood pressure, and symptom progression using digitally connected devices;

• communication of treatment modifications and other self-care while adhering to social distancing recommendations;

• treatment and monitoring at home to free up hospital resources; and

• if symptoms progress and hospitalization is necessary, direct admission can be arranged, eliminating the need for an emergency department visit.

Utilizing available technology to virtually manage patients gives physicians access to timely clinical information that allows for better medical decisions based on continuous and comprehensive data. The key benefits of remote patient monitoring include improved patient outcomes, readmission reduction, increased patient satisfaction, and reimbursement increases.

It’s important, however, to understand the distinction between telehealth visits and other virtual technology. In terms of Medicare reimbursement, virtual check-ins, e-visits, remote patient monitoring, and chronic care management are not considered telehealth. Therefore, the originating site and geographic restrictions in place prior to the public health emergency do not apply to these services.

The Long View
In light of the public health emergency, there have been a significant number of changes happening very rapidly. Many of the changes related to the availability of telehealth needed to happen regardless. But the question remains, how will these changes affect health care long term?

From a telehealth standpoint, patients now have broader access to care using technology-based solutions. These changes can improve overall patient care, patient satisfaction, and patient outcomes. In addition, during this public health emergency, it lowers further spread of the COVID-19 coronavirus by allowing patients to comply with shelter-in-place and social distancing recommendations while still having access to needed care.

Providers must continue to care for their patients with the ultimate goal in mind of flattening the curve. Telehealth and telemedicine give them that opportunity, not just with respect to COVID-19, but also in the continuation to manage the health of patients with chronic medical conditions.

— Virginia Gleason is senior manager of advisory services at nThrive.