Early in the COVID-19 pandemic, we saw exponential growth in the usage of telehealth. In fact, early growth of the industry displayed a 78X increase in the utilization of telehealth services verses the traditional, in-person office visits. As of July 2022, the utilization of telehealth has stabilized at levels 38X higher than before the pandemic, displaying signs that telehealth is not only here to stay, but it may be here to take over.
This drastic increase in usage, derived greatly due to necessity, was enabled by several factors, such as:
- Increased consumer willingness and confidence in the availability and practicality of telehealth;
- Increased provider willingness and confidence in the effectiveness of telehealth to be a legitimized and sustainable day-to-day practice of medicine; and
- Softened regulatory structure through both the Public Health Emergency (PHE) and the Consolidated Appropriations Act 2022 enabling greater access and reimbursement.
During the universal tragedy that was the pandemic, telehealth extended its hand as a bridge between traditional and modern care, offering the possibility to reinvent the way that we view virtual and hybrid practices, with the common goal of the healthcare "Triple-Aim" (access, outcomes, and affordability) still at the forefront. Furthermore, CMS National Health Expenditure data estimates display that there are strong signals in a shift of US healthcare spending upwards of $250 billion dollars from traditional, in-person care to virtual or virtually enabled care.
However, reaching this threshold of change is nowhere near a foregone conclusion, and it would likely require sustained consumer and clinician adaptation and accelerated redesign of care pathways to incorporate virtual modalities. These adaptations will further revolve around the inevitable reality that these COVID-19 exceptions will not last forever, and it is essential that providers are prepared to respond to these revoked privileges.
Some of the privileges, or exceptions, that are connected to the PHE and Consolidated Appropriations Act of 2022 and will expire at the end of the 151-day waiting period are as follows:
- Increased flexibility regarding where the patient receives Medicare telehealth services, as well as where the services originate will revert back to match the restrictions that were in place prior to the COVID-19 public health emergency.
- Medicare reimbursement for mental health telehealth services will again require an in-person visit within 6 months of initial assessment and every 12 months following.
- Medicare reimbursement for telehealth visits furnished by physical therapists, occupational therapists, speech language pathologists, and audiologists will no longer be allowed.
- Medicare will no longer cover audio-only visits for physical health encounters.
- FQHCs and RHCs will no longer be able to be reimbursed as distant site telehealth providers for non-mental health services.
With a recent rise in omicron variant cases and continuing pressure from healthcare providers and consumer advocacy groups to maintain flexibilities, the federal government remains pressed to further extend the PHE. Therefore, although the expiration of the current PHE was set for July 15th, we have confirmation today that another 90-day extension will be issued. For healthcare providers, this means that PHE telehealth flexibilities will be "safe" until at least October 2022, and, further, the exceptions deriving from the Consolidated Appropriations Act of 2022 will extend to March of 2023. Although Congress has several bills on its floor to codify enhanced virtual medical assistance, these bills will likely be sidelined for quite some time.
Everyone is looking for solutions to develop permanent policies and craft a sustainable practice, and, here at MDRXLAW, we are at the forefront of this search. In later blogs, we will dive into specific practice areas in the telehealth sphere. These fields will include mental health/psychologist services, pain management, dental, and multidisciplinary practices.
In the meantime, if you are in need of expert healthcare counsel regarding the further sustainability of your telehealth practice, or if you wish to expand your practice to include telehealth services, do not hesitate to contact our knowledgeable and experienced attorneys at (212) 668-0200 or by email at email@example.com.