Telemedicine and Medicare

Expanded Telehealth Coverage for Seniors:
​Why It Matters Now 

​Virtual care is key to social distancing, especially for older adults with chronic illness. A temporary shift in reimbursements could have positive long-term implications.

On March 17, the Trump administration announced the expansion of Telehealth services for Medicare beneficiaries during the COVID-19 pandemic — a direct effort to keep older adults with health problems at home to avoid exposure to the coronavirus.
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“Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered ... and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services,” Health and Human Services Secretary Alex Azar said in a prepared statement.

It’s a smart and welcome strategy that will allow millions of older adults to access virtual consultations from their homes or in assisted living communities. Some wider telehealth reimbursements already were enacted last year; this is poised to serve millions more.
And the effort is crucial, especially for high-risk individuals, as a growing number of shelter-in-place orders seek to limit unnecessary outings.

The benefits are part of a broader effort by the White House to ensure Americans of all ages are aware of telehealth and other accessible benefits to maintain good health while flattening the curve, according to the Center for Medicare and Medicaid services.

I’m hopeful that the expansion of telehealth during this global emergency will prompt wider and permanent coverage via Medicare to benefit a population that’s increasingly looking for a better quality of life and more ways to age in place.

Telehealth’s Benefits and How Coverage Is Expanding
Telehealth enables caretakers to virtually screen patients, answer questions and make treatment recommendations without exposure to a hospital or clinic where a person could contract or spread the virus. Providers can also see patients in any geographical location, greatly easing the stress on busy organizations fighting the pandemic.

Consider how helpful this option could be for people who have mobility issues or lack transportation — not to mention those with diabetes, heart or lung problems, or other conditions that could hinder their prognosis if they contracted the novel coronavirus.

Still, there are divides that must be addressed. Despite telehealth’s steady growth and acceptance nearly 9 out of 10 companies with 500 or more employees offered virtual care as part of their health benefits last year — telehealth coverage under traditional Medicare has been relatively limited until now.

Prior to March 17, Medicare’s telehealth reimbursements were mainly restricted to rural areas where patients were required to use kiosks in specially designated facilities. That’s of little comfort to people who want to avoid public spaces. Medicare last year also had begun paying for 5- to 10-minute virtual check-ins, but with many restrictions.

Under emergency declarations from the Trump administration, Medicare coverage now includes three types of virtual services that could have long-lasting impacts on how physicians and other professionals provide care to older adults:

• Telehealth visits: Expanded coverage will enable Medicare beneficiaries to seek real-time consultations, whether it be from a smartphone or computer, and the exchange needn’t be with their primary care provider. It’s not possible to diagnose coronavirus via telehealth, but patients can be virtually evaluated based on symptoms and be directed to in-person testing and treatment.
• Virtual check-ins: Medicare patients can initiate brief communications with their care provider to avoid unnecessary trips to the doctor’s office. These are intended for patients with existing ties to a care provider. This could include people with chronic illness who need routine check-ins that don’t necessarily require an office visit.
• E-visits: This service, also initiated by the patient, enables communication with providers that are typically done through the patient portal, rather than face to face. Mainly, this service allows for nonurgent communication at the patient’s leisure, where providers can follow up with care or advice for patients on how to best seek treatment.

Expansion of these services for older adults is intended to last only for the duration of the COVID-19 public health emergency. But as more lawmakers and clinicians discover the health benefits, convenience and cost savings of virtual care, there’s a strong argument to be made that the arrangement — properly scaled and managed — could become a way of life.

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From telehealth visits to digital pharmacies, seniors have ramped up technology use during COVID-19

Seniors have embraced technology during the COVID-19 pandemic, from booking virtual visits with their doctors to ordering their prescriptions online.

Telemedicine usage jumped 340% among Medicare-eligible seniors since the start of the COVID-19 pandemic, according to a new survey.

Nearly one-third of consumers age 64 and older say they monitor their health using a wearable. What's more, 4 in 10 are interested in a wearable that helps them and those around them maintain appropriate social distance, according to a survey from healthinsurance.com.

The survey debunks the idea that only younger consumers widely use technology. Results were based on an online pool of more than 1,000 Medicare eligible consumers aged 64 and older conducted from July 17 to July 20.

Six in ten seniors say they are embracing technology more during the COVID-19 pandemic. One-third (34%) report using an online pharmacy.

Prior to COVID-19 only 1 in 10 used telemedicine. During COVID-19, 44% have used telemedicine and 43% say they intend on using it after, according to the survey.

Of those who used telemedicine, 58% say they have used it just once and 30% report using it once a month. Two-thirds of those who haven't tried telemedicine said the reason is simply because they haven't needed the service. 

The survey results are in line with other polls that have found Medicare members are taking to telehealth.
A poll conducted by Morning Consult and sponsored by the Better Medicare Alliance back in May found that roughly half of seniors are comfortable using telehealth to get healthcare, and those that do largely say they had a favorable experience.

Data from insurance giant UnitedHealth also shows that the telehealth sector is making inroads with specific hard-to-reach demographics.

Telehealth adoption has rapidly increased among seniors according to the company's data. And patients in rural areas also are gravitating toward telemedicine, according to John Walthour, vice president of research at UnitedHealth Group.

The Centers for Medicare and Medicaid Services (CMS) has reported that telehealth usage has surged in the past four months. Before the public health emergency, approximately 13,000 beneficiaries in fee-for-service Medicare received telemedicine in a week. In the last week of April, nearly 1.7 million beneficiaries received telehealth services, CMS data shows.

President Donald Trump issued an executive order Monday to permanently expand some telehealth services beyond the COVID-19 pandemic. Policy changes from CMS also support the increased use of telehealth among Medicare beneficiaries.

The healthinsurance.com survey also found that seniors are using online tools to research their healthcare options.

Nearly 8 in 10 research their Medicare options online. Forty-four percent enroll using the internet, and the remaining 56% sign up either in person or on the phone.

Healthcare costs are a top concern about seniors, the survey found. Two-thirds say they are worried about out-of-pocket medical costs. Six in ten are worried about an unexpected medical bill, so much so that 36% have put off seeing a doctor because of cost.

These concerns could impact how surveyed seniors vote in the upcoming 2020 presidential election.
Nine in ten say lowering drug prices is important to them and 68% say the economy and healthcare are the two most important issues to them in the 2020 election. 

And, it turns out, certain behaviors are pretty universal during the COVID-19 pandemic as everyone is encouraged to stay home. 

Case in point, almost half of seniors admit to binge-watching. And cheers to all the virtual happy hours—half of surveyed seniors also say they have video chatted more since the start of COVID-19.

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Medicare telehealth expansion could be here to stay. Here’s where things stand

KEY POINTS

• At least 10 million Medicare beneficiaries have used telehealth since early March, compared with about 13,000 weekly appointments pre-pandemic. 
• Lawmakers and regulators are looking at making some of the current expansions permanent.
• Among the issues that policymakers would need to address are the cost and quality of remote care, as well as determining which services are appropriate for telemedicine.

In early March, U.S. health officials had a stark warning for older Americans: You are more at risk for complications if you contract Covid-19, so avoid leaving your home.

For Medicare’s 62.5 million beneficiaries — the majority of whom are 65 or older and more likely to use medical services — this was more than an inconvenience or new threat. It meant needing to see a doctor could pose a dangerous choice.

Enter telehealth. As communities worked to stem the spread of the coronavirus through temporary business shutdowns and stay-at-home orders, lawmakers and regulators loosened policies to make remote health care through Medicare more broadly available during the public emergency.


Whether via video chat, a telephone call or other remote technology, telemedicine usage among Medicare beneficiaries spiked from pre-pandemic levels: At least 10 million Medicare beneficiaries have used telehealth since early March, according to a spokesperson for the Centers for Medicare and Medicaid Services. Before then, there were roughly 13,000 appointments weekly.

“I think it’s pretty clear that the expansion in telehealth services was a very appropriate and successful response to the pandemic,” said Juliette Cubanski, deputy director for the Kaiser Family Foundation’s program on Medicare policy. “It was probably a lifesaver for people who took advantage of it, or it let them continue to get care.”

Yet as Congress and regulators consider making the temporary expansion in telehealth permanent, patient advocates are hoping they don’t move too quickly. 

“We have data about increased utilization, but we don’t know much about the beneficiary’s experience and what’s working and what isn’t,” said Lindsey Copeland, federal policy director for the Medicare Rights Center, an advocacy group.

Among the issues that policymakers would need to address are quality of care, the cost to beneficiaries and the services that are sensible for coverage.

“Using it for all circumstances and all services, as we’ve seen generally through the pandemic, might not be the best possible way forward from both a program cost perspective or beneficiary cost perspective,” Cubanski said.

By the looks of it, most telehealth experiences have been positive among Medicare beneficiaries. Among those enrolled in an Advantage Plan, 91% reported favorable experiences with telehealth and 78% would use it again, according to a survey by the Better Medicare Alliance.

Similarly, an informal poll done in an 8,000-member Facebook Medicare group hosted by insurance agency Boomer Benefits showed that most respondents who had used telehealth liked the arrangement — often with the caveat that it wouldn’t work for every medical issue encountered. Others questioned whether the cost should be the same as an in-person visit.

Debbie, a 65-year-old Medicare beneficiary living near Middletown, Delaware, used telehealth — a face-to-face video on her smartphone — to get treatment for a bout of poison ivy. For reasons that include the nurse practitioner’s inability to see the allergic reaction in detail over video, she said she was unimpressed.
I don’t think anyone thinks telehealth would replace in-person 100%. But there’s a strong feeling that there is a role for telehealth visits.
Allyson Schwartz

PRESIDENT AND CEO OF THE BETTER MEDICARE ALLIANCE
“I don’t like it,” said Debbie, whose last name is not being used for privacy reasons. “Even if you can see each other [on the screen], it’s not the same as seeing someone in person.”

Prior to the pandemic, telehealth already was on a path toward broader usage within Medicare. However, it was generally limited to rural areas, with restrictions on where the remote visit could take place and which providers were allowed to offer such care.

During the public health emergency, beneficiaries can be in their own home, and the menu of services and providers that qualify was greatly expanded, ranging from emergency department visits to group psychotherapy to radiation treatment management.

In Congress, there are several bills addressing telehealth expansion. The HEALS Act — introduced in the Senate as the Republican version of the next coronavirus relief package — includes a provision that would make the regulatory waivers permanent through the end of 2021. The Trump administration also is pushing for some permanency in telehealth usage with Medicare.

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Another issue to address is Medicare beneficiaries’ access to technology, as well as the know-how to use it. For some patients, that could be a barrier to care. 

“If we have this expansion in telehealth, we have to do it in a way that doesn’t leave those people further behind and increase existing disparities,” Copeland said.

Policymakers would also need to identify which services are most appropriate for telehealth appointments.

“There’s no question that there still needs to be in-person visits, but there are some that are highly appropriate for telehealth,” said Allyson Schwartz, president and CEO of the Better Medicare Alliance and a former congresswoman from Pennsylvania. 

For example, she said, check-ins for people with chronic conditions or mental-health consultations have worked well for those remote appointments.

“I don’t think anyone thinks telehealth would replace in-person 100%,” Schwartz said. “But there’s a strong feeling that there is a role for telehealth visits.”

“I don’t like it,” said Debbie, whose last name is not being used for privacy reasons. “Even if you can see each other [on the screen], it’s not the same as seeing someone in person.”

Prior to the pandemic, telehealth already was on a path toward broader usage within Medicare. However, it was generally limited to rural areas, with restrictions on where the remote visit could take place and which providers were allowed to offer such care.

During the public health emergency, beneficiaries can be in their own home, and the menu of services and providers that qualify was greatly expanded, ranging from emergency department visits to group psychotherapy to radiation treatment management.

In Congress, there are several bills addressing telehealth expansion. The HEALS Act — introduced in the Senate as the Republican version of the next coronavirus relief package — includes a provision that would make the regulatory waivers permanent through the end of 2021. The Trump administration also is pushing for some permanency in telehealth usage with Medicare.

Another issue to address is Medicare beneficiaries’ access to technology, as well as the know-how to use it. For some patients, that could be a barrier to care. 

“If we have this expansion in telehealth, we have to do it in a way that doesn’t leave those people further behind and increase existing disparities,” Copeland said.

Policymakers would also need to identify which services are most appropriate for telehealth appointments.
“There’s no question that there still needs to be in-person visits, but there are some that are highly appropriate for telehealth,” said Allyson Schwartz, president and CEO of the Better Medicare Alliance and a former congresswoman from Pennsylvania. 

For example, she said, check-ins for people with chronic conditions or mental-health consultations have worked well for those remote appointments.

“I don’t think anyone thinks telehealth would replace in-person 100%,” Schwartz said. “But there’s a strong feeling that there is a role for telehealth visits.”

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Medicare to expand telehealth for elderly

Medicare said Tuesday that it will immediately expand coverage for telemedicine nationwide to help senior citizens with health problems stay home to avoid exposure to the coronavirus.

The new Medicare option will allow millions of older people to take care of ongoing medical problems as well as new concerns, while heeding public health advice to stay home during the outbreak.

For example, a patient with diabetes wouldn't have to postpone a regular follow-up visit with the doctor to keep safe -- he could do it via Skype. And people concerned that they may have the virus could "see" their doctor or nurse practitioner virtually to find out how to get tested in person.

"It helps us prevent the spread of the virus," said Medicare administrator Seema Verma.

For senior citizens who don't navigate technology, relatives or friends can assist. "If it's your mom, you may need to go over to her house to help her do this," Verma said. But don't visit if you're feeling sick, she warned.

Risk of serious illness from the coronavirus is greater for older people and those with underlying health problems such as lung conditions, diabetes or heart problems. Many Medicare beneficiaries are managing chronic health issues that put them at heightened risk. The telemedicine expansion is geared directly to that vulnerable group.

Current telehealth coverage under traditional Medicare is limited. It's available in rural areas, and patients need to go to specially designated sites for their visits. Since last year Medicare has also been paying for brief "virtual check-ins." Tuesday's announcement goes beyond that, allowing clinicians and hospitals to bill Medicare for visits via telemedicine that previously had to take place in person, at a medical office or facility.

The policy change carries out a waiver of Medicare rules recently authorized by Congress and set in motion under emergency declarations from the Trump administration. Expanded telemedicine coverage will remain in effect during the outbreak.

PRIVATE INSURERS
At a White House briefing Tuesday, Verma said the federal Centers for Medicare and Medicaid Services is also encouraging states to expand the use of telehealth in their Medicaid programs for low-income people. Separately, Medicare Advantage plans offered by private insurers have been allowed to offer telemedicine as a supplemental benefit, like dental coverage or a gym membership, for several years now. The private plans serve about one-third of Medicare's more than 60 million beneficiaries.

For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

Medicare is the government's flagship health insurance program, covering people age 65 and over, as well as younger people who qualify because of disability. About 40 million people are in traditional Medicare, the government-administered part of the program that was the focus of Tuesday's announcement.

Doctors' groups and hospitals had been urging Medicare to make the move. Under Tuesday's announcement:

• Patients and clinicians will need a two-way visual and voice connection that allows real-time interaction. Laptops, tablets and smartphones should work. Penalties for potential violations of federal health care privacy laws will be waived for good-faith efforts to serve patients.
• Hospitals and a range of clinicians, including doctors, nurse practitioners, clinical psychologists, nutrition professionals and licensed social workers will be able to offer telehealth. Nursing home residents will also be able to consult doctors via telehealth.
• Standard Medicare copays and deductibles still apply to telemedicine visits. But there's flexibility. Normally, health care providers cover such copays for telehealth visits. During the coronavirus emergency, health providers will be allowed to waive or reduce cost-sharing for telehealth visits.
• Legislation authorizing the waiver required medical offices to have an established relationship with a patient to bill for telehealth services. But Medicare said it will refrain from enforcing that requirement via audits during the coronavirus public health emergency. Verma said that's to allow for circumstances such as a medical practice being forced to close because of the outbreak.

"Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered ... and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services," Health and Human Services Secretary Alex Azar said in a statement.

If telemedicine shows its worth in the coronavirus emergency, it could lead to permanent changes making it more widely available to senior citizens.

Telehealth has grown steadily in recent years. Most midsize or large employers now offer some way to connect patients and health care providers virtually.
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But researchers say patients have been relatively slow to try telemedicine, especially if they are used to in-person visits.

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​Why TeleHealth is here to stay

Tele consultation may not be a silver bullet for all COVID-19 related problems, but it will help hospitals and doctors to continue with patient consultations anytime – anywhere, improving the hospital’s image and at the same time maintaining a steady revenue stream

The concept of tele consultation has been around for a while, but its use was extremely limited or almost no-existent in regular doctor and patient interactions. But the COVID-19 pandemic changed everything and now it has become the platform for choice.

Today physical distancing measures are of the utmost importance, even while regular consultations, especially for lifestyle diseases, senior citizens, and specifically for those having heart diseases, high / low BP, diabetes, and other ailments, cannot be missed.

Consultations in hospitals substantially increases the possibility of infections for doctors as well as patients. For hospitals, it adds various overheads in terms of mandating the use of PPEs for everyone attending patients, additional sanitization of hospital buildings/consulting rooms, patients’ pre-health checkups, and much more. These factors add significant costs, reduce productivity and burdens hospitals to the point of break down.
Tele consultation may not be a silver bullet for all these problems, but it will help hospitals and doctors to continue with patient consultations anytime – anywhere, improving the hospital’s image and at the same time maintaining a steady revenue stream.

Tele consultation will not replace the need to visit hospitals completely in foreseeable future as some basic investigations and physical check is not possible, but it is a great blessing when physical meetings are not an option for patients and doctors. There is a possibility that in future wearables will be able to collect certain clinical parameters and add further value to the telehealth proposition but affordability for masses may become a concern.

All in all, industry experts observe that tele health has made serious inroads in patient care and it is definitely here to stay.