On May 11, 2023, the federal public health emergency (PHE) will come to an end. While COVID-19 is still a public health priority, the U.S. is in a much better spot with COVID-19 cases today than we were three years ago. A recent Department of Health and Human Services (HHS) report shows that daily reported COVID-19 cases, deaths, and hospitalizations are all down by at least 80%. These numbers indicate a need to scale back some aspects of the U.S. response to the PHE. With this reduction will come some changes to reimbursement, insurance coverage, and the overall impact of telehealth. Ryan Kelly, Executive Director for the Mississippi Rural Health Association, recently went on AFMC TV to discuss the state of telehealth and how providers can continue to utilize telehealth after the PHE ends in May.
Ryan is also on the Advisory Board for the South-Central Telehealth Resource Center, part of the National Telehealth Resource Center. These resource centers are all across the country in different divisions divided across different states. The resource centers focus on growing and expanding telehealth education to assist in understanding these states' policies and providing some examples of what telehealth can do. They are the cutting edge of telehealth research and innovation.
The PHE provided opportunities for telehealth providers to adopt telemedicine. Many had not previously done so before the pandemic due to low reimbursements. With the PHE ending in May, the future of telehealth may look a little different. “With the PHE ending, everyone’s afraid telehealth is going to go away, and I remind them that telehealth had existed well before the pandemic,” Ryan says. What will be changing will be the widespread utilization of telehealth services. During the pandemic, telehealth utilization increased dramatically. “The Centers for Medicare & Medicaid Services (CMS) had a near 300 times increase in telehealth utilization,” Ryan said. “We knew that after the pandemic, these numbers would decrease, and it did. 300 times is not a sustainable number, but we’re still at 38 times the utilization of telehealth than we were pre-pandemic.”
Common Telehealth Changes
With the PHE ending, most states in the Southeast, particularly those contiguous to Arkansas, have extended provisions for telehealth that they initiated during the pandemic:
- Provider extensions have decreased. During the pandemic, some states used emergency authority to waive certain aspects of their state licensing requirements, allowing for providers to deliver telehealth services in states where the provider is not licensed. With the PHE ending, these provisions are likely no longer needed.
- Audio-only telehealth is not as widely accepted. During the pandemic, many payors extended coverage of audio-only telehealth services due to the PHE. For example, some insurers allowed audio-only office visits (codes 99201–99215) for Medicaid and commercial insurance customers. Reimbursement provisions are changing for these major payors. UnitedHealthcare (UHC), one of the nation’s largest health insurers, now only reimburses audio-only telehealth services for codes listed in Appendix T of the 2023 CPT manual, which does not include the codes for audio-only office visits.
- The safety and security of telehealth platforms have returned to pre-pandemic recommendations. HIPAA never recommended that any providers use non-HIPAA compliant platforms, but in an emergency situation, providers used the only technology they had at their disposal. “The entire time, we have suggested that people use a wide variety of cost-effective platforms that they can take on, especially in the age of major cyber security issues,” Ryan says.
- A reimbursement decision for rural health clinics and federally qualified health centers using telehealth has been delayed until 2024. Ryan’s team has been actively lobbying for this reimbursement on the federal side to ensure that it’s being written into the federal code. “From there, it’s just a matter of how we can make it grow and progress.”
Ensuring Telehealth is a Viable Option for Patients and Providers
One of the most important changes affecting telehealth's future is a special provision allowing rural facilities to utilize telehealth services. While legislation has not been created to allow telehealth usage in rural clinics post-PHE, Ryan says there is no opposition. “It’s just a matter of how we get this provision pass.” Ryan says one of the obstacles preventing legislation from acting more quickly is that the Office of Management and Budget is grading telehealth as a cost to the federal government and taxpayers. “I completely disagree with that analogy, as many do because telehealth has been seen time and time again to be a cost saver. You’re focusing on wellness and prevention in primary care and offsetting the cost of secondary, specialty, and emergency care.” Other than the cost concern, Ryan says no legislator on either side of the aisle is against this provision.
Another important factor that affects telehealth’s future success is adoption. It is rare to find any providers who are opposed to telehealth. Providers often find it to be beneficial for patients and easy to use. “[Providers] like the fact that the recording can be stored in their electronic medical record, so they can refer back to it.” Artificial intelligence can be incorporated with telehealth systems now to allow for transcription and note-taking.
Telehealth Changes the Way We Practice
As Ryan mentioned, telehealth can save patients and taxpayers money in the long run. For example, if a patient with diabetes is treated with insulin, that is extremely expensive for Medicaid or other commercial insurers. It is also detrimental to the patient. “Someone with diabetes costs the federal government or the taxpayer 25 to 30 times more than the average patient does with the treatment and number of visits they have to refill their insulin,” Ryan says. Telehealth allows providers to catch someone with prediabetes and put them on insulin or other medication that would lower their A1C and prevent that patient from developing full diabetes., which can save them and the taxpayer hundreds of thousands of dollars. Down the road, telehealth can integrate with artificial intelligence to predict health outcomes and allow for other advancements in medical practice. “If used correctly, telehealth can reduce the overall cost of our health care system and make it better than we’ve ever imagined it to be,” Ryan adds.
For more information on telehealth, check out the full AFMC TV episode with Ryan Kelly.
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