Authored by: Peggy Kelly
The pandemic transformed healthcare delivery. In 2018, only 14% of physicians worked in practices that had established telehealth capabilities, but that percentage jumped to 74% post-pandemic, according to the American Medical Association.
As we move further away from the pandemic and rules are re-examined, impacts could reach practice operations, workflows, and reimbursement.
Recently, the House panel advanced a bill extending telehealth rules created during the pandemic, such as Medicare waivers allowing practices to treat patients remotely. Changes are similar to an extension passed earlier in the year by the House Ways and Means Committee.
Staying in tune with ongoing changes in telehealth policy is important for medical practices, especially when it comes to opportunities for public comments, which could influence the outcome of decisions.
Behavioral health remains in flux
When it comes to telehealth, behavioral health is still an area that remains mostly in flux. During the pandemic, partial hospitalization was allowed via telehealth, and patients received intensive outpatient care at home. Before the change, an in-person visit was required within six months of the first telehealth consult, after which an in-person visit was required each year. However, starting January 1, 2025, those in-person requirements could revert to pre-pandemic rules, with that proposal still under review.
Another area of impact is the prescribing of controlled substances via the telehealth relationship. The DEA and HHS recently accepted public comments about proposed changes. Over 40,000 members of the public commented, and many of the larger medical associations participated during that period. Ultimately, those comments were heard and considered, which influenced the outcome.
As a result, behavioral health providers should pay close attention to telehealth shifts, how those changes impact the patient relationship, when providers need to bring people into the office, and what medications are still acceptable to prescribe via telehealth.
Medicare could lead the way with primary care reimbursements
Telehealth has become an important part of primary care, especially for monitoring patients with chronic conditions. In the past, a patient might have needed to visit their practitioner every two to four weeks to monitor their blood sugar, blood pressure, and other vitals. Now, they can perform these activities remotely. Services such as remote patient monitoring are also impacted by telehealth policy changes, which continue to be re-evaluated.
Additionally, CMS is still taking the lead with virtual visits and reimbursements. The challenge is that there are some assumptions about virtual visits not being the same as having patients in the physical office—and about the associated costs.
As long as Medicare continues to reimburse at non-facility rates, it’s hopeful that commercial payers won’t push back too much on telehealth reimbursements. However, if Medicare determines they’ll only reimburse at the facility rate, it might kick off a slippery slope for decreased reimbursement.
For example, a phone visit reimbursement is well under $50, whereas for a facility office visit, you’re looking at $50 to $90, which is quite a significant difference. As a result, this is an area to watch.
The future of telehealth requires diligent awareness
Telehealth has had its share of growing pains, and now that we have some distance from the pandemic, lawmakers continue to sort out what the future looks like for care and reimbursements.
As you stay current with future changes, watch payer bulletins, public-facing websites, and payer portals, which typically have the most current reimbursement rates. You can also lean on the expertise of your RCM partner, which will often track telehealth policy changes on your behalf.