Thread by @ml_barnett

VERY big telehealth news

Medicare is now covering telehealth:
1) For any patient (not just rural)
2) Equal payment to standard office visits
3) In any setting (mobile phone, home etc)
4) No requirement to have seen patient in-person first

cms.gov/newsroom/fact-…

Also this one is really big - no enforcement of HIPAA violations to "serve patients in good faith"

They specifically mention Skype or FaceTime as reasonable methods for a visit!!

They are also waiving lots of restrictions on two types of services called "virtual check ins" and "e-visits"

Virtual check in = brief communication (5-10 minutes) with an ESTABLISHED patient not related to a recent office visit (or upcoming one in 24 hours)

A virtual check in can also be: "Remote evaluation of recorded video and/or images submitted by an established patient including interpretation with follow-up with the patient within 24 business hours"

as long as it's not related to a recent office visit or one within 24hrs

This is potentially a big deal because so many primary care docs, in particular, will be making phone calls to touch base with lots of patients.

Being able to bill for this without having a formal "video" visit is vary liberating.

So then what is an "E-Visit"?

Medicare has a very specific definition: "non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals"

Here's a big deal too - non-physicians like PT can bill for these

Going back to telehealth reimbursement, Medicare says it will loosen restrictions for any services that can be billed via telehealth - that's a lot of stuff! See a list of codes here:

cms.gov/Medicare/Medic…

CMS is also letting Medicaid plans off the hook for loosening telehealth restrictions quickly without special CMS approval, as long as their rates don't differ from those offered in-person

medicaid.gov/medicaid/benef…

It will be very interesting to see if Medicare can bring things back to the old regs once COVID-19 passes. Or maybe it won't want to!

Once doctors and patients learn how much care you can deliver without an office visit things may start to change ...

I would summarize these policies as basically bringing telehealth policy to what a consumer would reasonably expect in the present day.

Much of telehealth policy was trapped in a weird utilization management, expensive HIPAA-compliant tech world

Next - @CMSGov @SeemaCMS should reimburse for eConsults too!

We want to reduce referrals to specialists that can be resolved with a quick physician interaction in the COVID era too.

Wouldn't that be something if physicians were actually paid to communicate with each other.

@CMSGov @SeemaCMS I will say one more thing. It's funny how no one is asking right now whether telehealth or e-visits save money. That's because it DOESN'T MATTER if they provide a valuable service.

Slowing Medicare cost growth is much more than preventing doctors from doing what makes sense

@CMSGov @SeemaCMS *DOESN'T MATTER as long as the cost is not prohibitive

Except that the prohibitive cost for covering really expensive new drugs or medical devices doesn't seem to get in the way much

Why are innovative delivery models any less important than a new, convenient drug or device?