Advocates have long called for broader adoption of virtual doctor visits, but it took the coronavirus pandemic to push telehealth into the mainstream. Federal data shows that over 12.1 million Medicare recipients received some form of remote care from mid-March to mid-August as health care providers and patients sought to keep themselves safe from infection this year.
The boost was supported by the Centers for Medicare and Medicaid Services, which took dramatic steps to loosen rules and increase reimbursements for telehealth visits.
Insurers and employers for years have been urging the use of telehealth as a low-cost alternative for nonemergency care. But patients were wary about signing up and Medicare was slow to embrace it, which limited telehealth to certain types of visits for patients in rural areas.
That changed with COVID-19. In response to the pandemic, CMS removed barriers to telehealth coverage, allowing patients throughout the country to access care from their homes.
New services added
The agency this year has added 135 services to the list of telehealth it will pay for during this public health crisis, including non-COVID-19 doctor visits, initial inpatient visits with a new practitioner, discharge services and cardiac and pulmonary rehabilitation treatments. CMS also increased the types of health care providers who can use telehealth, waived patient copays and boosted reimbursement rates to amounts similar to those paid for an in-person visit.
"We saw growth in telehealth go from 0.1% of patients to 40% of our Medicare members," says Dr. Saurabha Bhatnagar, chief medical officer and head of technology and performance at UnitedHealthcare Medicare and Retirement. "I was astounded."
Whether any of these changes will become permanent remains to be seen. CMS is evaluating telehealth usage during the pandemic while still keeping an eye out for inappropriate use and fraud. In August, the agency released a proposal to permanently allow services such as home visit evaluations and to extend payment for several telehealth services beyond the current coronavirus emergency.
"It’s hard to imagine merely reverting to the way things were before," CMS Administrator Seema Verma wrote in an article for Health Affairs published in July.
Advocates worry that permanent changes could limit health care access for some patients. Seniors who live in areas with limited broadband and low-income Medicare recipients who may not be able to afford the devices or telephone minutes necessary to receive telehealth services could be especially vulnerable.
"Before making changes permanent, careful study is needed to examine whether telehealth in its current state is exacerbating disparities and determine how to rectify identified concerns," the Center for Medicare Advocacy said in a press release.
Nonetheless, COVID-19 has cleared the path for telehealth, in some form, to stick around. Here’s what you can do to make the most of it.
Understand when telehealth makes sense
To avoid infection, Medicare beneficiaries have been using telehealth as a safer substitute for all types of medical care. But in more normal times, it’s important to remember that some kinds of care are more appropriate for virtual visits than others. For example, follow-up visits for an already diagnosed disease or condition work well, while seeing a physician for a new health concern may be better done in person.
Mental health services seem to work particularly well virtually, says Christopher Ciano, president of Aetna Medicare. The remote option may encourage people to get care who may not be willing to seek this help otherwise, he says.
Use the technology you like best
Medical privacy laws and other government regulations limit the types of technology that telehealth providers can use to certain platforms. But the pandemic has opened the door to every manner of virtual communication, including everyday tools such as FaceTime and Skype.
"We want to make a doctor visit as easy as a FaceTime call to a loved one," Bhatnagar says.
In addition, CMS has been reimbursing health care providers for telephone services at similar rates to in-person visits, a big change. Let your provider know what technology you’re most comfortable with when you make a telehealth appointment.
Check your copay
Many Medicare providers and Medicare Advantage insurers have waived copays for telehealth visits during the pandemic. Going forward, it’s likely Medicare patients will pay the same copay as for in-person doctor visits. With all the changes in billing sparked by the pandemic, it's a good idea to ask ahead of your appointment what your cost-sharing will be.