Early in this series, we discussed the need to lift CMS virtual care and telehealth restrictions related to the patient’s originating site and attending physician. Today we focus on reimbursement parity for inpatient telemedicine.
When the needs of patients suffering from the novel coronavirus triggered changes to CMS reimbursement policies, many private health insurers also authorized comparable payments for services received by either remote or in-person providers.
As a result, telehealth claims with private insurance providers increased year-on-year by more than 4000%.
The increase in access to remote providers benefited:
- Patients in need of care but reluctant to risk a visit to their physician or hospital during a viral outbreak
- Physicians concerned about their patients suffering from chronic diseases and the viability of their practice as the nation shutdown to prevent the spread of the virus
- Hospitals focused on providing emergency care to both coronavirus sufferers and more common health crises were able to increase access to specialists and expand hospitalist services.
As the pandemic continues to strain our healthcare system, many Americans are realizing that hospital revenue is closely tied to elective procedures. In rural communities, the lack of revenue from these procedures is putting hospitals at risk of closing.
What happens now?
Hospitals that continue to operate under the umbrella of emergency declarations will continue to bill for inpatient and outpatient virtual care and telehealth services at a rate comparable to in person care. Payments for virtual care will help protect hospitals, communities and patients from detrimental economic and health impacts, including:
- Increased furloughs and reduced employment of healthcare workers
- Lack of access to health services – due to ongoing fear, quarantine orders and furloughs of healthcare providers
- Hospital closures – a trend that began well before the pandemic – brought on by unstainable healthcare payment models
Make no mistake, administrators and local officials know that community hospitals are critical to the economic viability of small communities. Doctors and nurses furloughed in rural areas will inevitably seek job openings in other locations. It’s not difficult to imagine the impact:
- Hospitals lose revenue, furlough employees and struggle to manage costs.
- Furloughed employees, unable to support themselves and the local economy, seek out new positions in areas able to provide employment stability.
- Communities suffer from reduced access to care and economic damage as the skilled healthcare workforce leaves the community.
What is the solution?
For those of you that have been following this series during the crisis, we have outlined the steps required to eliminate barriers to virtual care and telehealth:
- Centers for Medicare & Medicaid Services must make permanent changes to telemedicine regulations and reimbursement.
- States must act to increase access to telemedicine for Medicaid patients.
- Physicians, particularly specialists, must be able to work across state lines – expansion of the Interstate Medical Licensing Compact is one possible solution.
- The Department of Health and Humans Services must adapt DEA registration to suit an interconnected healthcare system – for patient safety, appropriate regulation and telemedicine expansion.
- CMS must recognize and adapt to the physician shortage and patient demand by eliminating payment restrictions that require the telemedicine billing site to be within a Health Professional Shortage Area or related designation.
- All insurers, public and private, must pay for telemedicine services at the onsite equivalent.
If we’ve learned anything from this crisis, the importance of a stable healthcare system is critical to wellness and our economy. Eagle believes that the changes outlined above will have a positive impact on our healthcare system, communities and patients. Join us in supporting the expansion of telemedicine, write your congressional representative.