Expansion of Telehealth Under the COVID-19 Pandemic

Telehealth is the use of electronic information and telecommunications technologies to support clinical health care, public health, patient health-related education, and health administration, as defined by the Health Resources and Services Administration (HRSA) (3). Examples of telehealth include the use of mobile health apps and wearable monitoring devices that track a patient’s vitals, provide alerts about needed care, and help patients access their physician (2). In the United States, the COVID-19 pandemic has led to increased pressure on the Centers for Medicare and Medicaid Services (CMS) to permanently expand telehealth services (1). 

Before the COVID-19 public health emergency, CMS prioritized telemedicine innovation. However, most Medicare payment for telehealth services was limited to the services located in what are referred to as “originating sites,” either a rural health professional shortage area or a county outside of a Metropolitan Statistical Area. In response to stay-at-home orders to reduce risk of exposure to COVID-19, telehealth services were made more accessible, helping people who require routine care (2). 

On March 13, President Trump made an emergency declaration under the Stafford Act and the National Emergencies Act that would allow CMS to expand the scope of Medicare to cover telehealth visits at no additional cost and in any location (1). The declaration also permitted CMS to add 135 allowable services–including emergency department visits, home visits, and speech therapy visits–and expanded the range of practitioners to physical therapists, occupational therapists, and so on. 

Following these changes, there was a jump in weekly virtual visits for CMS beneficiaries, from approximately 14,000 pre-pandemic to almost 1.7 million in the last week of April 2020 (4). The frequency of telehealth visits even after in-person primary care visits resumed in May indicated that the expansion of telehealth services would merit permanency. The continued expansion of telehealth proved to be more convenient and accessible while also cutting costs (6). 

In August, the Trump administration directed the U.S. healthcare system to make permanent the temporary flexibilities for telehealth allowed earlier in the year. The executive order outlined plans to help support this and allow for the infrastructure necessary for telehealth expansion, such as establishing funding and technical assistance for rural communities (5).  

In establishing telehealth as a healthcare staple, it is important to acknowledge the barriers to entry involved: resistance to change, access to the appropriate technology,  reimbursement, and data security among others (6). The continued expansion of telehealth is a complex challenge, however, it is also an opportunity to ensure better and more equitable healthcare outcomes at a lower cost. 

References 

1. Morse, S. (2020, August 03). Telehealth to become permanent under Trump executive order. Retrieved September 30, 2020, from https://www.healthcarefinancenews.com/news/telehealth-become-permanent-under-trump-executive-order 

2. Verma, S. (2020, July 15). Early Impact of CMS Expansion of Medicare Telehealth During COVID-19. Retrieved September 30, 2020, from https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/ 

3. What is telehealth? How is telehealth different from telemedicine? (2019, October 17). Retrieved September 30, 2020, from https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine 

4. Executive Order on Improving Rural Health and Telehealth Access. (n.d.). Retrieved September 30, 2020, from https://www.whitehouse.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/ 

5. Landi, H. (2020, August 11). CMS launches new alternative payment model for rural healthcare providers. Retrieved September 30, 2020, from https://www.fiercehealthcare.com/hospitals/cms-launches-new-payment-model-to-boost-funding-to-rural-healthcare-providers 

6. Healthcare in the Post-Covid World: 16 Ways Telehealth Trends Could Transform Care. (2020, September 28). Retrieved September 30, 2020, from https://www.cbinsights.com/research/telehealth-transform-healthcare-post-covid-19/