CareCloud Advocates on Behalf of Physicians Regarding CMS Telehealth Guidelines

In response to the pandemic CMS has made tremendous changes to their telehealth policies. Geographical and HIPAA restrictions have been  waived, a host of new telehealth CPT codes were added, and doctors are  finally given the flexibility to reduce or waive cost-sharing for telehealth patients. Despite popular support, the majority of these changes are set to revert when the pandemic is officially declared to be over. 

CareCloud has recently written a comment to CMS regarding  the desire of many physicians for CMS to maintain the updated telehealth policies. The following is a summary of CareCloud’s statement. 

Background

According to CMS data, a remarkable 45% of primary care visits during mid-April were performed via telehealth. The country has found a new normal, in which patients have realized the benefits of seeing their physicians virtually. 

The changes to telehealth regulations are set to revert by the end of the public health emergency (PHE). This sudden reversal would compromise the significant progress made by enhancing healthcare delivery to U.S. patients. Considering this, CareCloud would like to propose the following policy recommendations:

 

  • CMS should continue to readjust their outlook regarding telehealth
  • The geographical restriction waivers should be made permanent
  • CMS should continue to give doctors the flexibility to reduce or waive cost-sharing for telehealth patients
  • CMS should return to requirements regarding HIPAA compliant technology
  • Physical and occupational therapy services should be extended under Category 3

 

CMS should continue to readjust its overall outlook regarding telehealth.

The pandemic has pushed CMS to alter antiquated views of telehealth. When telehealth was first introduced as a possible method of care, CMS limited telehealth reimbursement to rural patients who had no alternatives. Telehealth visits were only reimbursed if the patient was located in a rural location, and the physician conducted the visit from their medical office or facility. Patients then faced the difficulty of finding a doctor willing to work for the significantly reduced prices offered for telehealth visits. These, and other restrictions, strangled the use of telehealth and limited its practicality.

In response to the PHE, CMS has removed the majority of telehealth restrictions that have led to profoundly successful patient access. We suggest that CMS maintains its current approach to telehealth for four primary reasons: 

  1. telehealth reduces patient opportunity cost
  2. conserves medical resources
  3. encourages preventive care
  4.  reduces the spread of communicable diseases

Telehealth reduces patient opportunity cost due to the elimination of commute and physician wait time. A study published in the American Journal of Managed Care found that the average patient spends over an hour and a half driving to, and waiting for, their visit. The per visit opportunity cost equates to roughly $43 – a nationwide opportunity cost of $52 billion each year. 

Telehealth conserves medical resources. According to the CDCover one-third of patients aged 18-64 stated that the reason for their last emergency department visit was not due to the “seriousness of the medical problem.” Telehealth could meet the patients’ needs and reduce the exorbitant costs that accompany the average emergency room visit. Fewer patients using the emergency room for less severe issues would free-up emergency departments to provide critical care for more serious cases. 

Telehealth encourages the use of preventative care. Preventative care is commonly understood to be the single most important aspect of any healthcare system. According to CMS, “chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths,” and these diseases are “often preventable.” Telehealth is a safe, easy-to-use form of preventative care which patients can access without inconveniencing themselves. According to a study highlighted by the CDC, telehealth can be effectively used in preventative care to improve medication adherence, clinical outcomes, and dietary outcomes.

Telehealth reduces the spread of communicable diseases. This is possibly the most important use case, having been recently demonstrated during the COVID-19 pandemic. Healthcare-associated infections have remained a significant risk for patients despite the implementation of safety protocols. Now, more than ever, patients are worried they will acquire a deadly infection at their healthcare facility. According to the U.S. Department of Health and Human Services, “At any given time, about 1 in 25 inpatients have an infection related to hospital care. These infections lead to tens of thousands of deaths, and cost the U.S. healthcare system billions of dollars every year.” 

Geographical restriction waivers should be made permanent. 

The geographic restrictions, which stringently limited telehealth use to patients in rural locations, are no longer useful. When these guidelines were created, telehealth was a futuristic idea for which the technology was inadequate. Despite technological shortcomings, policymakers understood that telehealth was the only option for many rural patients. Now the world has changed; telehealth has become a cutting-edge solution for healthcare delivery, capable of solving patient needs in an efficient, safe, and cost-effective manner. The technology surrounding telehealth has changed, and consequently, the policy must evolve to reflect this reality. Therefore, we suggest that geographic restrictions be completely discarded.

CMS should continue to give doctors the flexibility to reduce or waive cost-sharing for telehealth patients.

Doctors desire to provide high quality care to all patients, regardless of patients’ means. Many patients continue to struggle with the economic impacts of the current PHE, and allowing doctors the flexibility to reduce or waive cost-sharing for telehealth will result in the potential for decreased costs and additional patient usage of telehealth. Consequently, fewer patients will visit an in-person hospital or clinic, potentially draining in-person resources and spreading disease.

CMS should return to requirements regarding HIPAA compliant technology. 

CMS’ decision to waive various HIPAA regulations was a wise choice during the pandemic. This was a timely decision that assisted the country as physicians made the sudden switch from in-person care to telehealth. However, physicians now face a serious risk of losing patients due to potential security issues. The longer HIPAA requirements are waived, the further patient information is jeopardized. Particularly during a pandemic when hackers have been especially active. For this reason, we strongly advise CMS to transition to their previous policies concerning HIPAA compliant technology.

Physical and occupational therapy services should be extended under Category 3. 

We deeply appreciate the efforts CMS is making to trial new telehealth CPT codes under Category 3. We fully endorse the CPT codes CMS has chosen to include under Category 3, and we feel confident that CMS will make them permanent come 2021. While we believe that CMS has done an admirable job choosing services to file under Category 3, we would also suggest the addition of the following physical and occupational therapy CPT codes: 92521-92524, 92507, 97161-97168, 97110, 97112, 97116, 97535, 97760-97761, 99217-99226. CareCloud believes that CMS should use Category 3 to test the previously mentioned CPT codes and judge their long-term feasibility as telehealth services.

Conclusion

We appreciate the opportunity to comment on these guidelines and recommend the above suggestions as telehealth is rapidly incorporated into the U.S. healthcare system.

Telehealth has the potential to eliminate overall cost, expand access to care, conserve medical resources, and reduce community spread. Provided that CMS continues to modernize American healthcare through the implementation and expansion of telehealth services, we feel that physicians will finally be given the tools to care for all of their patients.

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