When the Centers for Medicare & Medicaid Services (CMS) first announced expanded Medicare health coverage on March 23rd, the details were ambiguous while the message was clear: Getting patients quality health services remotely via telemedicine in response to the Covid-19 pandemic is now a priority.
The full raft of changes, announced March 30th, now include 85 health services previously unavailable remotely, as well as paying clinicians to provide these services. While these changes are a clear response to the COVID-19 pandemic, they are also part of a continuing trend in modern healthcare.
In October 2019, months before the first outbreak began, President Trump signed an executive order directing CMS to begin streamlining telemedicine regulations. Now, healthcare providers across the US are implementing real-world methods of providing the highest level of care using remote technologies. Some of these shifts are meant to be temporary, in response to the pandemic. Many, however, are the inevitable result of a healthcare system that must provide high-quality care throughout the 2020s and beyond.
Here are some of the main shifts patients, administrators, and healthcare workers will be implemented in the coming weeks and months, in order to both flatten the curve and ensure the best outcomes for every patient – no matter where they are.
Hospitals Without Walls
News reports of overflowing ICUs in several countries have made the need for more hospital beds a pressing reality. Since expanding the size of a hospital (or building a new one) is time and labor-intensive, CMS has loosened regulations that require patients to be treated in medical facilities. These new temporary rules allow hospitals to transfer patients to ambulatory surgery centers, rehab hospitals, and even hotels or dormitories, which are all covered under Medicare funding. CMS refers to this policy as Hospitals Without Walls.
The new guidelines also allow for ambulances to take patients to locations deemed appropriate for treatment at the discretion of the medical staff. The regulations explicitly allow for medical staff to send less critical Covid-19 patients to hotels and dormitories for recovery, while patients needing more care would remain in the hospital ICU.
Expanded Telehealth Coverage
Allowing providers to bill for telemedicine services at the same rate as in-person visits have, essentially, leveled the playing field for both methods of care. This aspect of the bill was emphasized in a press conference by a CMS spokesperson, who emphasized that they were “getting rid of long-standing barriers to telehealth in the Medicare program.”
The types of visits allowed under the telehealth announcement are broad and include emergency department visits, physical rehabilitation, and home visits, among others. This also includes allowing physicians to supervise support staff where an in-person presence was previously required. These services can even be provided through audio-only channels; previously, both video and audio (videoconferencing) were required.
Deregulation to Meet Demand
These changes – which include more benefits and responsibilities for support staff, and reduced paperwork requirements – are not anticipatory or speculative. In the days leading up to CMS’ March 30th announcement, doctors in New York were reporting a 312% increase in the number of telehealth visits.
It remains to be seen which of these regulations will outlast the Covid-19 pandemic, or what further regulatory easements may be necessary to combat the virus. For now, the expansion in telemedicine services is likely the largest since the days of the house call, which itself began its precipitous decline following WWII. Judging by these CMS announcements, our 21st century global crisis will cause a different kind of shift in the way patients receive care that’s tailored to the state of our healthcare system.