By Jeanie Davis
In the early days of the COVID-19 pandemic, hospitals received the go-ahead to expand telemedicine/telehealth services via a waiver from the Centers for Medicare & Medicaid Services (CMS).
There was urgency to help people who needed routine care and to treat patients with mild symptoms in their homes so they would not have to travel to a hospital or clinic. This was focused on limiting community spread of the virus, as well as reducing the exposure to other patients and staff members to slow viral spread.
Across the country, case managers embraced the opportunity to add telemedicine to the tools used to diagnose and treat patients, says Vivian Campagna, MSN, RN-BC, CCM, the chief industry relations officer for The Commission for Case Manager Certification. “We’ve been working toward this point for many years. Now, CMS realizes telemedicine can be done well, and that it provides tremendous advantages and opportunities to improve outcomes.”
In the pre-COVID-19 days, CMS covered costs of telemedicine in specific circumstances. Patients were required to have an “established relationship” with the physician within the past three years. That stipulation disallowed a telemedicine professional from assisting during emergency and many more medical cases.
Before the waiver, Medicare could only pay for telehealth in limited circumstances, such as for patients in a designated rural area who leave their homes and go to a clinic, hospital, or certain other types of medical facilities for the service. Hospital patients could be seen only in certain “originating hospitals” approved by the Department of Health and Human Services (HHS), including county hospitals designated as Metropolitan Statistical Area sites or rural hospitals with health professional shortage. The attending physician was required to be on-site at the time of visit to bill Medicare, which complicated billing when telemedicine was involved. (More information is available at: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.)
With the waiver:
- Medicare can pay for office, hospital, and other visits furnished via telehealth across the country, including the patient’s home.
- The “originating hospital” and “attending physician” requirements have been lifted.
- Medicare will pay for telehealth services furnished in any healthcare facility, including any hospital across the country.
- A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, can offer telehealth to their patients.
- There is flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
HIPAA Restrictions Waived
The 2020 action also relaxed penalties with the Health Insurance Portability and Accountability Act (HIPAA). The HHS Office for Civil Rights (OCR) is waiving penalties against healthcare providers who treat patients using everyday communications technologies, such as FaceTime or Skype, during the public health emergency.
Even before the pandemic, CMS took steps to improve telemedicine for rural patients. In 2019, Medicare began paying for brief communications or virtual check-ins with healthcare providers. Medicare Part B also pays clinicians for e-visits, which are patient-initiated communications through an online portal. Medicare beneficiaries could receive telehealth services such as routine office visits, mental health counseling, and preventive health screenings.
The Case Manager’s Perspective
“For the case manager, telemedicine is an excellent tool to move patients effectively through episodes of care,” says Campagna. “Telemedicine opens up a whole new way to apply best practices and a high standard of care that result in better outcomes.”
This is especially important in rural areas. “Specialist services will be more readily available, which means patients won’t require transfer to another hospital that might be two hours away,” she explains.
She believes a teleconsultation also can help with patient education to clarify a diagnosis or treatment plan. For example, when both a specialist and a primary care doctor participate in a virtual consult with the patient, they can help the patient understand his or her condition, says Campagna. “The case manager also could participate in the consult to help reinforce and explain.”
Similarly, telehealth can improve post-discharge home care and reduce readmissions, Campagna says. “A televisit 48 hours post-discharge, with the patient and physician, is a chance to answer questions about the discharge instructions.” If a caregiver can join the discussion, that will help fully ensure best practices.
Telehealth also can be useful in the emergency department, bringing in specialists (like behavioral health) on an as-needed basis. “There’s no waiting for the doctor to arrive, which facilitates the patient’s treatment,” Campagna notes.
Overall, “the case manager’s workload becomes a bit easier because they’re able to work more efficiently with telemedicine visits,” says Campagna. “Whether you’re in a large metropolitan hospital or a rural hospital, there are multiple applications for telemedicine.”
While older patients may be uncomfortable with the technology, “I think they can get used to it,” says Campagna. “Especially for people who are elderly, not feeling well, or simply busy, there are so many benefits. I think the more experience seniors have with telemedicine, the more they will see the advantages.”