Eliminating audio-only telehealth coverage could put safety net clinics at risk

Although the increased use of telehealth for the duration of the pandemic allowed numerous patients to preserve obtain to care, reimbursement for a massive portion of these visits may conclude with the general public wellness emergency, developing issues for low-revenue patients who depend on these providers, according to a new study from RAND.

The study appeared at facts from billable outpatient primary care and behavioral wellness visits at forty one federally qualified wellness centers that operated at 534 destinations in California from February 2019 to August 2020.

For the duration of the pandemic, the FQHCs knowledgeable a speedy raise in telehealth usage as the clinics substituted in-person care for video clip and telephone visits.

For primary care visits, forty eight.1% occurred in-person, forty eight.5% by way of telephone and three.4% by way of video clip. Comparatively, for behavioral wellness visits, 22.8% occurred in-person, sixty three.three% by way of telephone and thirteen.9% by way of video clip.

Phone visits peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral wellness visits, according to the study.


The Centers for Medicare and Medicaid Solutions defines telemedicine as “the use of interactive telecommunications equipment that contains, at a bare minimum, audio and video clip equipment.”

Prior to the pandemic, CMS only reimbursed for telehealth providers if equally audio and video clip were used. But with the onset of COVID-19, the company issued non permanent flexibilities for vendors to get reimbursed for equally video clip and audio-only telehealth providers.

These flexibilities allowed thousands and thousands of susceptible patients to go on to receive care for the duration of the pandemic – primarily those who gained care at an FQHC, which delivers health care providers to people today of all ages, no matter of their capability to shell out or regardless of whether they have wellness coverage.

“More than three million beneficiaries have gained telehealth providers by way of conventional telephone,” mentioned former CMS Administrator Seema Verma in a Health and fitness Affairs blog. “That indicates nearly a person-third of beneficiaries that gained a telemedicine support did so employing audio-only telephone technology.”

In spite of that a important portion of telehealth visits for the duration of the pandemic were conducted more than the cellphone, CMS has signaled that it may end reimbursing for audio-only visits when the general public wellness emergency finishes.

“Although we are not proposing to go on to recognize these codes for payment underneath the PFS in the absence of the PHE for the COVID-19 pandemic, the want for audio-only interactions could remain as beneficiaries go on to consider to avoid sources of potential an infection, these as a doctor’s business,” the company mentioned in its 2021 Medical professional Charge Timetable truth sheet.

Getting rid of coverage for audio-only telemedicine visits would disproportionately impression underserved communities that may confront obstacles to accessing video clip technology, according to Lori Uscher-Selling price, the study’s guide writer and a senior coverage researcher at RAND.

“Lower-revenue patients may confront special obstacles to accessing video clip visits, while federally qualified wellness centers may absence assets to establish the required infrastructure to conduct video clip telehealth,” she mentioned. “These are essential concerns for policymakers if telehealth carries on to be greatly embraced in the future.”

THE More substantial Pattern

At the conclude of 2020, Congressmen Jason Smith (R-MO) and Tony Cardenas (D-CA) introduced the Permanency for Audio-Only Telehealth Act that would require CMS to go on reimbursing vendors for audio-only telehealth even just after the general public wellness emergency finishes.

The American Psychological Affiliation is a person of numerous companies that help the monthly bill.

“Enabling patients to receive mental wellness providers by audio-only telephone is a make a difference of wellness equity for underserved populations, and APA applauds this essential equalizer,” mentioned APA CEO Arthur C. Evans Jr., PhD. “This monthly bill will enable patients to receive providers at residence no make a difference wherever they reside − regardless of whether in rural, city or suburban communities.”

Even without the monthly bill, HHS expects to lengthen the general public wellness emergency by means of the conclude of 2021, according to a letter it recently despatched to governors.

Twitter: @HackettMallory
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