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Telehealth from pre-pandemic to now

Telehealth refers to any form of health care offered to patients remotely via phone, computer, email, text, etc.

 

 We already know the pandemic altered all of our lives for better or worse. But of the many things that dramatically changed, how did telehealth fare? 

When people were suddenly stuck at home, many patients sought alternative care options. Telehealth usage surged, increasing more than 11,718% in just a month and a half, per CMS data reported by Healthcare Dive. In fact, 1.3 million Medicare members received telehealth services in the week ending April 18, 2020, compared to 11,000 members in the week ending March 7. 

From October 2019 to October 2020, telehealth claim lines increased a whopping 3,060% nationally, per FAIR Health data.

Was anyone using telehealth before 2020?

Needless to say, telehealth wasn’t very widespread before the pandemic. The main reason? Reimbursement. Medicare only covered telehealth services under specific, limited circumstances, such as for patients in designated rural areas.

But that doesn’t mean the market wasn’t primed for a telehealth surge. Before the pandemic, telehealth usage was growing despite the restrictions and confines that barred a telehealth boom. For example, by March 2020, 19.5% of patients said they had, at some point, had a telehealth appointment, according to a Sykes patient survey. That’s already a huge increase from 2019, where only 8% of patients said they’d had a telehealth appointment at some point, per a 2019 American Well survey.

But in March 2020, the Centers for Medicare and Medicaid Services (CMS) broadened which telehealth services were covered during the public health emergency and removed geographic coverage restrictions.

 Here are some key changes CMS made in regard to their telehealth coverage.

Before the pandemic

Due to the pandemic

Only physicians and certain other practitioners were eligible to receive Medicare payment for telehealth.

CMS expanded which providers can get reimbursed for providing live, interactive telehealth services.

Providers had to have treated the patient in person within the past three years.

Providers can treat new patients via telehealth.

CMS did not pay anyone outside of physicians and certain other practitioners.

CMS will pay any healthcare professional that is eligible to bill Medicare for professional services.

Only telehealth visits composed of audio and video components qualified for reimbursement. 

Telehealth visits conducted via phone became eligible for reimbursement.

Patients must be in a medical facility to receive telehealth care.

Patients may be at home when receiving telehealth care.

Strict licensure requirements were in place. For example, patients and physicians must reside in the same state. 

Licensure requirements for physicians relaxed. For example, a physician can reside in a different state than the patient they provide care for.

A telehealth visit was not considered the same level of care as that of an in-person visit, therefore reimbursement would be less than an in-person visit. 

CMS created payment parity, which means provider reimbursement is the same rate, no matter if patients come to an in-person appointment or telehealth appointment. 


What's one of the best things about CMS providing more telehealth options? 

Private payers followed suit and saw spikes in telehealth usage. 

All of the national private payers who participated in a Center for Connected Health Policy analysis voluntarily expanded telehealth coverage for their commercial health plans during the worldwide health emergency. 

Blue Cross Blue Shield of Massachusetts, for example, processed more than one million telehealth claims within nine weeks of changing its policy to expand coverage for telephone and virtual visits at no cost to members during the COVID-19 crisis. In February 2020, it received approximately 200 telehealth claims per day, but by May 2020 it was receiving 38,000 per day.

Trust and satisfaction with telehealth also grew substantially over the past year for both patients and physicians.

Ok, so approximately 61.78% of patients in the Sykes survey only tried telehealth because their doctor’s office moved their appointments to virtual visits, but trust and satisfaction in telemedicine still grew. 

Pre-pandemic, 65.6% of patients felt hesitant or doubtful about telemedicine’s quality. Now, 87.82% want to continue using telemedicine for routine visits even after the pandemic. 

Pre-pandemic, 56.4% didn’t think telehealth would provide the same level of care as in-person visits. Now, 79.95% believe telemedicine can deliver high-quality care and 74.25% are willing to share health data from digital fitness trackers or smart devices with physicians.

The Harris Poll found that 35% of people would even replace PCPs for qualified and telehealth-enabled, on-demand physicians. About 50% of Gen Z and Millennials agreed.

What's next for telehealth?

In December 2020, CMS moved to permanently expand telehealth by adding 60 services to the Medicare telehealth list that will continue to be covered after the public health emergency. CMS also said at the time it would consider adding more in the future.

As of June 2021, many private payers are still covering telehealth services, and others have made the expansion permanent. In May 2020, Blue Cross Blue Shield of Tennessee became the first major insurer to permanently cover primary care, specialty care, and behavioral healthcare virtual visits with in-network providers.

Though efforts are still being made to permanently expand Medicare telehealth services nationally, many states are moving on their own to make telehealth coverage permanent. 

For instance, check out the bipartisan Protecting Rural Telehealth Access Act, introduced in June 2021.

Even though these changes can help so many people, barriers are still keeping the underprivileged and underserved from care. For example, RAND Corporation research found that telehealth usage among the privately insured increased mostly among people who are more affluent and those who live in metropolitan areas. 

Although there are so many things that we can still do to improve access to care, telehealth has made it possible to improve healthcare access for the nation’s most vulnerable patients. And that’s just the beginning. We likely have only experienced a small portion of telehealth’s potential. 

Interested to hear more about telehealth? Check out our free ebook, Telehealth: From the Boom to What’s Next.

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Rivet is a modern revenue cycle product suite that integrates with your EHR to allow you to see the big picture of what’s going on in your practice with payer contracts, fee schedules, denials and underpayments. You can also check eligibility and provide accurate up-front patient cost estimates before services are rendered. The Rivet team will help you aggregate your fee schedules and input your claims data to enable you to increase revenue and decrease A/R days. 

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