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On Monday, August 3, 2020, President Trump signed an executive order to expand access to telehealth services for the 57 million Americans living in under-served rural areas. The Executive Order on Improving Rural and Telehealth Access will ensure that the expansion of telehealth services due to the COVID-19 pandemic will continue after the nationwide public health emergency is declared over.
In 2019, Medicare started paying for virtual check-ins with doctors to determine whether an in-person visit was required, but the pandemic saw access to virtual visits expanded significantly in an effort to help prevent the spread of COVID-19. Geographic restrictions were lifted, and telehealth services were made available to Medicare beneficiaries across the country. The Centers for Medicare and Medicaid Services (CMS) also added a further 135 medical services to the list of services that are covered by Medicare if provided virtually.
Figures from the CMS show that virtual visits via phone or video increased to nearly 1.7 million in the last week in April, compared to just 14,000 visits before COVID-19. From mid-March, when the telehealth restrictions were relaxed, to mid-July, 10.1 million Medicare beneficiaries received a Medicare telehealth virtual visit. While there was a fall in the number of virtual visits in May once in-person visits resumed, the number of patients opting for virtual visits remained high, indicating patients are happy with medical services being provided virtually.
Americans living in rural locations are more likely to die from the five leading causes of death in the United States than individuals living in urban areas, and the gap has widened between 2010 and 2017. “Prior to the pandemic, telehealth was fine, but it wasn’t anything raging, and I guess one of the only good things that we’ve gotten out of this horrible situation is that telehealth has been increased,” said President Trump. “It is the purpose of this order to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth.”
President Trump also called for officials to develop a plan within 30 days to increase investment in the communication infrastructure to improve healthcare in rural areas and within 30 days, the Secretary of the HHS will announce a new model to test new payment mechanisms to ensure that healthcare providers in rural areas can provide the necessary level of and quality of care to patients. Under the new model, healthcare providers in rural areas will be given more flexibility from current Medicare rules, and the model will establish predictable financial payments and encourage the transition to high-quality, value-based care. A report will also be submitted by the HHS Secretary on policy initiatives to increase rural access to healthcare through the removal of regulatory burdens which limit the availability of clinicians, prevent disease and mortality through rural-specific initiatives to improve health outcomes, reduce maternal mortality, and improve mental health in rural communities.
Shortly after the Executive Order was signed, the CMS announced it is proposing changes that will expand telehealth services for Medicare beneficiaries permanently, consistent with the Executive Order. The proposed CMS rule also includes a multi-year program that aims to reduce the burden on clinicians as part of its Patients Over Paperwork initiative and will ensure that there will be appropriate reimbursement for the time clinicians spend with patients. The CMS is also proposing that some of the additional medical services covered under Medicare during the public health emergency will also continue to be paid for by Medicare if provided virtually, including virtual visits for certain evaluation and management services and some services for patients with cognitive impairments.
The CMS is seeking public input on which services should continue to be covered by Medicare once the public health emergency is declared over. The CMS also wants to temporarily continue telehealth services for emergency department visits to give the industry time to assess whether they should also be made permanent. Comments on the proposed changes are being accepted until October 5, 2020.
“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for Americas seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”