In the months since the CMS revised telemedicine regulations to help expand uptake of virtual care, adoption has surged. But what happens after COVID-19?
"There's absolutely no going back."
That's what Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma told Becker's Hospital Review in April in an article about the future of telemedicine regulations after COVID-19.
Her comments came about two months after the federal government first issued temporary new rules to facilitate and expand telehealth uptake during the pandemic. In the few months since, both patients and providers have cozied up to virtual care: Becker's added that telehealth visits surged from 10,000 to 300,000 per week (and are likely ticking up from there).
But what exactly has changed - and what do the changes mean now and in the future? Here's what policymakers have said so far.
A rundown of telemedicine tegulation changes
The CMS telemedicine expansion changes have come in iterations, three now to date: The first wave came in mid-March, the second on March 30 and the third on April 30. All of them boil down to expanding access, loosening restrictions and improving reimbursement for telehealth services.
Providers can now practice good-faith telemedicine on any virtual platform, including everyday services like FaceTime, Zoom or Skype. Many services can also take place with an audio-only phone visit, including behavioral services, patient education and some evaluation and management visits. Reimbursement rates for those audio services now align with similar office and outpatient visits.
Any practitioner who takes Medicare patients can get reimbursed for telemedicine services, including physical and occupational therapists and speech-language pathologists. This expands previous restrictions, in which only certain providers like physicians or nurses could deliver virtual care.
Home-based and inpatient rehab
Hospice, home health providers and inpatient rehabilitation providers can engage in telemedicine, as long as it aligns with the patient's care plan. CMS has also waived the hospice and home health requirements for nurse visits every two weeks.
Distant site allowances
Rural clinics and federally qualified clinics previously known as "distant sites" can now deliver telemedicine to Medicare patients. Before, they could not get reimbursed for telehealth visits.
Reimbursement rates of many telemedicine visits now match those of in-person visits. Use the correct billing codes for telehealth encounters, such as 99201 through 99205 (new patients) and 99211 through 99215 (established patients).
Short check-ins can now take place via phone or video chat for new patients, not just those who are already established, as was previously the rule.
The golden moment of telemedicine
Right now, the only endpoint for these changes is language that specifies "for the duration of the COVID-19 emergency." Nobody knows when that will be, but there will come a time when the crisis subsides and regulators will have to sort through which reforms to make permanent and which to adapt in a post-pandemic reality.
Officials haven't made those decisions, at least not publicly: Verma's comments were hinting but vague nonetheless. And yet, plenty of experts have ideas. Already, some groups like the National Association for Home Care & Hospice have requested that elements favorable to their stakeholders remain intact, mHealth Intelligence reports.
But as beneficial as many of the changes are, questions remain about what virtual care will look like on the other side of COVID-19.
One grey area is that the loosened restrictions on technology platforms do raise concerns about cybersecurity and privacy issues. In anticipation of those potential modifications, providers may consider investing in more secure platforms now to prepare for the reining in of relaxed rules. This guide from the American Medical Association may help.
Experts and policymakers will no doubt iron out these details and more as time goes on, but meanwhile, one thing's for sure: Now is the golden moment of telemedicine, and physicians have more opportunities than ever to take part.