Conferences and News about Making Telehealth Changes Permanent

July 7, 2020

For those of us working on telehealth and risk adjustment, it’s been a whirlwind recently with the ATA2020, AHIP Institute, and RISE National conferences all happening.  (I also dropped in on the very cool Spark + AI Summit, but that’s a topic for a different blog.)  Let’s take a look at some of the telehealth news coming out of these conferences and from our national and state capitals.

First up, we have news from the AHIP Institute, where almost all experts are saying telehealth usage will increase over prior levels:

“Experts say there’s no going back now that hospitals and doctor’s offices are investing in the tech, payers are reimbursing for it and consumers, including traditionally tech-wary seniors, have gotten a taste.”

with some citing uncoordinated state and federal regulations as one of the challenges to volumes as high as they have been since the public health emergency waivers first took hold in March. 

We are also starting to see some specifics as to which telehealth regulations are going to become permanent. CMS proposes to continue telehealth flexibilities in its home health proposed rule. It’s nice to see in black and white, “one of the first flexibilities provided during the COVID-19 public health emergency that CMS is proposing to make a permanent part of the Medicare program,” and mHealth Intelligence reported from ATA2020 that “CMS officials have reportedly been receptive to extending more telehealth freedoms beyond the current state of emergency, and NAHC officials have said they’re thinking about expanding telehealth coverage for home healthcare.”  They also shared the remarks from Emily Yoder, an analyst in CMS’ Division of Practitioner Services, that

“CMS expects to file proposed regulatory changes for Medicare coverage of telehealth in mid-July in the Federal Register, and urged telehealth providers and advocates to be ready to comment on the proposals.”

This is consistent with the news that the Physician Fee Schedule rule will include permanent telehealth expansions.  This article summarizes the change in consumer sentiment as the driving force behind the changes:

“‘The patient trust barrier has been broken. There is no going back,’ said Brady, who serves as chief of staff to the deputy secretary and senior adviser to HHS Secretary Alex Azar. ‘Telehealth is now the preferred method. People want this as the first site of care. We are seeing a demand from consumers.’ ”

Meanwhile, in Idaho, we see the beginning of states making emergency changes permanent.  Governor Brad Little made permanent more than 150 emergency rules enacted since March to address the coronavirus pandemic, and the Idaho Statesman shares his viewpoint:

“Our loosening of health care rules since March helped to increase the use of telehealth services, made licensing easier, and strengthened the capacity of our health care workforce, all necessary to help our citizens during the global pandemic.  We proved we could do it without compromising safety. Now it’s time to make those health care advances permanent moving forward.”

And boy did telehealth usage increase, with the article citing “Due to the restrictions being lifted, there were about 117,000 telehealth visits from March to May. By comparison, there were only 3,000 telehealth visits in the same time frame of 2019.”

Expect these changes to be just the tip of the iceberg, with so many people talking about permanently making telehealth easier.  There is activity where 340 organizations plead with congress for permanent telehealth reform. If you follow the link, there are some great data points mentioned, like a 4,300% year-over-year increase in telehealth claims for March.  These are the four points the letter asks Congress to prioritize:

1. Remove obsolete restrictions on the location of the patient
2. Maintain and enhance the Department of Health and Human Services’ (HHS) authority to determine appropriate providers and services for telehealth
3. Ensure Federally Qualified Health Centers and rural health clinics can furnish telehealth services after the public health emergency ends
4. Permanently authorize HHS to issue temporary waivers during public health emergencies

This ties in with the Senate hearings demonstrating support for permanent changes to some telehealth policies as medical professionals advocated in support of maintaining and strengthening expanded telehealth-enabling provisions and a bipartisan group of 30 senators called for making telehealth expansion permanent.  Next up, the House is getting ready to debate extending CARES Act telehealth coverage indefinitely.

We expected these topics to get the early attention, but for the risk adjustment world, the applicability of diagnoses from telehealth encounters for RA is the key regulation whose fate we continue to wait to hear about.  It seems extremely unlikely CMS will expand the current regulation to allow audio-only encounters to risk adjust.  Continuing the status quo of counting HCCs from telehealth visits using video would be a welcome move.

Other telehealth resources

I wanted to take a moment to mention two additional resources, for those who work in these areas.  First is a HHS FAQ about risk adjustment for the ACA commercial market.  This document dates all the way back to April 27 (which is about a year and a half in crazy pandemic time units), but I haven’t linked it previously.  The first paragraph summarizes risk adjustment for the HHS-HCC model more succinctly and better than I ever could (emphasis is mine):

 “Any service provided through telehealth that is reimbursable under applicable state law and otherwise meets applicable risk adjustment data submission standards may be submitted to issuers’ External Gathering Data Environments (EDGE) servers for purposes of the HHS-operated risk adjustment program.  If a code submitted to an issuer’s EDGE server is descriptive of a face-to-face service furnished by a qualified healthcare professional and is an acceptable source of new diagnoses, it will be included in the risk adjustment filtering.  Telehealth visits are considered equivalent to face-to-face interactions, but are still subject to the same requirements regarding provider type and diagnostic value.”

Another great resource is guidance CMS issued on the use of telehealth encounters for eCQMs. This page links to separate documents for the 2020 and 2021 performance periods.  It’s good to see this level of detail for physicians participating in MIPS, APM, and the Medicaid Promoting Interoperability Program.