ATI Contributor: Allison Rizer
Expanding access to telehealth is a top strategy to prevent avoidable hospitalizations and increase the capacity of our health system during the current crisis we are experiencing. This is particularly important for the frail elderly population, which is experiencing the highest rate of adverse outcomes and death during the COVID-19 outbreak. States, providers, and health plans can each help expand reliance on telehealth to enable real-time, remote diagnosis, triage, and treatment of this population.
COVID-19 is showing us a lot about the readiness and capacity of our broader healthcare ecosystem—a system that experiences misalignment in supply and demand even in the best of times. As the population demographics in this nation become increasingly older, care delivery models have attempted to keep up by expanding home-based care, caregiver supports, and innovative senior housing models. But in a crisis like we are experiencing now, these models are taxed in ways no one could have anticipated and something is becoming increasingly clear: Telehealth is getting its moment in the spotlight, and for good reason.
Beyond the obvious advantage of not bringing COVID-19 into a brick-and-mortar healthcare space when individuals are asymptomatic or have a mild case of the virus, telehealth allows a provider to treat a patient virtually, avoiding the need for a mask or gloves – supplies that are becoming increasingly sparse. Telehealth accelerates diagnosis, triage, and treatment, freeing up critical beds and rooms for the patients who really need them. Furthermore, telehealth allows providers who themselves might be quarantined to continue seeing patients.
The Centers for Medicare & Medicaid Services (CMS) has expanded telehealth benefits in the Medicare fee-for-service (FFS) and Medicare Advantage (MA) programs over the past few years, albeit with considerable guardrails on: eligible services and geographies; which provider types can render these services; where an individual must be to receive telehealth services (the “originating site”); and where the provider must be located (the “distant site”). Now, in the midst of the COVID-19 outbreak, CMS is temporarily shifting those guardrails in a way that may provide telehealth access to significantly more individuals. Two of the more consequential Medicare changes include:
- Expanding eligibility to FFS individuals outside rural areas; and,
- Allowing the originating site to include an individual’s home.
CMS also issued clarifying guidance to State Medicaid programs on how to reimburse for telehealth services.
The Growing Trend
Telehealth utilization had been growing even before the COVID-19 outbreak, with an increase in the Medicare program of 500% between 2008 and 2014, and the highest growth in utilization among those aged 85 and older. COVID-19 is fueling this growth even more; some providers have noted increases of 50-300% in their telehealth utilization over the past few weeks, and the telemedicine company Amwell pointed to an 11% increase in urgent care telehealth visits in early March.
In addition to hospitals, this growing trend could be particularly important among facility types and individual providers who typically serve high-risk individuals (those with underlying conditions and/or advanced age). Expanded use of telehealth by these providers could protect their high-risk patients from COVID-19-infected persons coming into a facility or office unnecessarily, as well as to offer safer access to care for individuals who are able or required to remain in place. For example, telehealth could prevent SNF residents from a trip to the hospital when they have an acute episode unrelated to COVID-19.
The AMA has released a “Quick Guide” to help healthcare providers expedite their implementation of telehealth that provides information on policy updates, licensure, CPT codes, workflow, and other considerations. Amwell similarly has an “eBook” to help providers roll out telehealth. Providers choosing to forego implementing or expanding telehealth now, while they triage the myriad other issues they are currently experiencing due to COVID-19, could result in significant difficulty addressing health system challenges later.
Some shorter-term considerations to improve telehealth access during this outbreak and to help decrease the spread of COVID-19 include the following approaches, by stakeholder group:
What comes next?
COVID-19 will have a lasting impact on care delivery in our country with how we contemplate and address capacity and how we care for our most vulnerable. In so many ways, COVID-19 is showing us our system gaps, but it’s also demonstrating the agility of our system to respond with alternative and innovative approaches (necessity is the mother of invention). Telehealth is one of those approaches. Regardless of this crisis, telehealth holds promise in the aging and long-term care space, but now more than ever, states, providers, and plans should look for ways to expand access to this benefit.