Telehealth and the End of the Public Health Emergency

From the Field 

During the early months of the COVID-19 pandemic, the US government declared a public health emergency (PHE) that allowed some flexibility in the services CMS was able to provide coverage for. At the time, swift change was needed in the way providers were able to deliver care to patients and receive reimbursement to keep their practices operating. While there were many changes to how and where providers were practicing medicine due to the pandemic, the changes made to telehealth coverage felt as though they were bringing coverage standards into alignment with available technology and the needs of many patients.

Prior to the PHE, CMS had quite a few conditions for coverage of telehealth that were rather restrictive. The technology approved for use for telehealth communications was prohibitively expensive for some providers whose patients would greatly benefit from telehealth visits. In addition to technological restrictions, telehealth was only covered if the originating site and distant site met specific criteria, and not all Medicare provider types were able to furnish services via telehealth. During the PHE, telehealth went from being an option for a small percentage of patients to a common way for providers to deliver care to their patients.

It goes without saying that not all patient-provider encounters can or should take place via telehealth, but the PHE has allowed us to see some of the practical benefits of using telehealth. In the nephrology practices my company works with, one of the biggest benefits of the telehealth flexibilities during the PHE was the ability to have a visit with a patient over a telephone call. A sizable percentage of elderly patients with kidney issues encountered barriers using technology that allowed for the visual portion of the telehealth encounter, but they were able to review lab results and medications as well as discuss other pertinent information regarding their health with their nephrologist during a telephone call. This was incredibly beneficial for this already medically fragile patient population to have the option to avoid crowds at their physician office and still receive the care they needed.

Unfortunately, CMS doesn’t have the sole authority to keep telehealth coverage the way it is after the PHE ends; for that, they will need congressional action. CMS appears to be gearing up for an end to the PHE, publishing a roadmap for the end of the PHE. To help provider offices prepare for the end of the PHE and the changes that will occur, the Secretary of Health and Human Services (HHS) has agreed to provide a 60-day notice before ending the PHE. At the time of this writing, the PHE is set to last through mid-October. However, as HHS has not given a 60-day notice, it is likely the PHE will last through at least mid-January and possibly mid-April 2023.

CMS is encouraging providers to prepare for the end of these flexibilities and begin to move forward reestablishing previous health and safety standards and billing practices. In the CMS road map for the end of the PHE (https://www.cms.gov/blog/creating-roadmap-end-covid-19-public-health-emergency), there are links to documents specifically for physicians as well as ESRD facilities. These documents outline the changes specific to these provider types that can be expected at the end of the PHE.

Several key telehealth flexibilities have been proactively extended for 151 days after the end of the PHE. The flexibilities include no rural limitation, originating and distant sites allowing services to occur from the patient’s (and provider’s) home, and coverage for audio-only encounters. As the PHE has existed for more than 2.5 years, it is possible that some of the staff in provider offices are not familiar with many of the rules, regulations, and administrative requirements that will be coming back with the end of the PHE. Now may be a good time for providers, practice managers, and facility administrators to get together and review the CMS roadmap and plan for any needed training or policy changes.

Sarah Tolson is the director of operations for Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD dialysis programs, nephrology practices, and interventional nephrology. Your questions are welcome, and she can be reached at stolson@sceptremanagement.com, 801.775.8010, or via Sceptre’s website, www.sceptremanagement.com.