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Tracking the current and future status of telehealth for private practices

With no concrete answers on how the regulatory world may affect telehealth visits and reimbursement beyond 2020, here’s what the post-pandemic era may hold for virtual care.

For many private healthcare practices, relaxed and expanded telehealth reimbursement policies have helped maintain profitability during the COVID-19 pandemic. The allowances and technology have also helped healthcare providers keep patients and staff safe and healthy.

During the initial presence of COVID-19 in the U.S., the Centers for Medicare and Medicaid Services (CMS) promptly lifted regulations on how and where telehealth could be delivered and reimbursed. Commercial insurers quickly followed suit, providing reimbursement rates for telehealth visit types comparable to traditional office visit reimbursement rates.

In addition, geographical restrictions were lifted, patient cost-sharing fees were reduced or waived, and even telephone consults could qualify for reimbursement.

This rapid shift to telehealth opened the door for nearly all practices to manage their patient care and business virtually. Now, with telehealth volumes stabilizing far above pre-pandemic levels and stabilizing, providers wonder what the post-pandemic era will mean for the future of telehealth.

A closer look at 2020 telehealth growth

This year’s boom in telehealth adoption has been remarkable. The pandemic introduced telehealth to millions of patients who were unlikely adopters in a pre-COVID world. A look at claims data provided by FAIR Health’s Monthly Telehealth Regional Tracker offers a close look at the utilization of telehealth based on 31 billion private claim records. It shows that telehealth claim volume has risen from a miniscule 0.17 percent of claim records in August 2019 to 6.07 percent in August 2020 — an increase of 3,552 percent. 

The post-COVID reality is that this acceleration will likely have lasting implications on the future of healthcare delivery. With telehealth on the mind of providers, payers, and regulatory agencies, organizations are taking swift action to hardwire this digital transformation into their long-term operations.

Pre-COVID telehealth adopter Kaiser Permanente, who had been conducting an average of 40,000 telehealth visits per weekday in July, established a Digital Experience Center to focus on how “digital advancements can be leveraged” to better engage with members and patients. In September, the Food & Drug Administration (FDA) launched a Digital Health Center of Excellence to take a closer look at digital health policies and regulations.

At small to midsize healthcare practices, the willingness to integrate telehealth into daily operations may depend on insurers’ future reimbursement plans. Regardless of the public health emergency (PHE) we’re facing now, the long-term potential benefits of telehealth for private practice providers should not be underestimated.

Telehealth: a business opportunity for medical practices of all sizes

Prior to COVID-19, telehealth was a $3 billion business, used primarily for  virtual urgent care and patients in rural settings. Today, consultants estimate the digital healthcare business could represent up to $250 billion annually.

A recent report by consultants at McKinsey & Company suggests that 24 percent of office visits could be done virtually, with another 9 percent done “near virtually.” 

Implementing telehealth is no longer a question of if, but when. Provider adoption of telehealth has risen from 18 percent before COVID-19 to an estimated 48 percent. That aligns with a PatientPop survey in August 2020, in which 48.5 percent of patients said they already had a telehealth appointment with a provider in 2020.

Savvy medical practices with a real growth strategy understand the digital delivery of healthcare is here to stay. For those yet to adopt telehealth, or who don’t have a telehealth strategy, it’s best to consider both the benefits of firmly adopting digital health and the risks of waiting too long.

A comprehensive report by the consulting firm The Advisory Board says:

“Failure to support telehealth now will have serious costs for providers, even if the outlook for reimbursement and policy is unclear. Expectations of patients, payers, and emerging competitors demand that provider organizations integrate telehealth into practice.”

Think about telehealth as offering a competitive advantage in your market (one-third of provider organizations haven’t adopted telehealth at all). It also gives you greater flexibility to expand hours — and increase visit volume, if you so choose — and a path to additional revenue.

In the October 2020 PatientPop article Making telehealth work at small and midsize private healthcare practices, we provide tips on types of patients and patient visits that are best to consider for your telehealth strategy.

In general, assuming you are reimbursed for the visit, any opportunity to bring convenience and care to your patients without the need for an in-person exam can present a worthy opportunity.

Patient demand for the convenience of telehealth

Some naysayers think the telehealth boom will subside once COVID-19 is behind us. Most experts disagree.

McKinsey researchers
believe the demand for telehealth will remain high for at least the next 12 to 18 months while vaccine development concludes and distribution ramps up. By then, virtual care is likely to be even more widespread than today. More patients will have experienced the technology — and prefer it — and providers will know when and how to use telehealth to its greatest potential.

We already see proof of that patient preference and satisfaction. In the PatientPop survey data from August 2020, three out of four patients (75.8%) were satisfied with their telehealth visits. Roughly the same amount (76.2%) would prefer a telehealth visit in the future.

Patients cited saving time (61.5%), getting an appointment more quickly (47.5%), and overall convenience and comfort (36.9%) as key telehealth benefits. 

The Advisory Board report referenced above indicates that three out of five consumers in every age group would consider a virtual visit rather than wait just one day for an in-person appointment.

While telehealth will never replace all visit types, striking the right balance of in-person care and telehealth is the future of successful healthcare delivery. Using telehealth for follow-up appointments, simple consultations, and routine monitoring are great ways to keep your patients engaged and adhering to their treatment plan — critical for those participating in value-based reimbursement.

What to expect for the future of telehealth reimbursement

Most experts agree the pandemic’s acceleration of telehealth adoption is a sign that the industry has forever changed. To paraphrase comments made in June by CMS administrator Seema Verna, “now that the [telehealth] genie’s out of the bottle, there’s absolutely no going back.”  She’s also said that “reversing course would be a mistake.”

While CMS has been eagerly supporting telehealth throughout the pandemic, they have not yet offered concrete details on what the future will hold.  

One line of thinking is that for private payers to continue reimbursing for virtual care, healthcare providers will have to prove telehealth works from a quality perspective, particularly for patients with chronic conditions like heart disease, diabetes, or depression. Today, many lawmakers are lobbying to permanently expand Medicare payment for telehealth.

While the long-term potential for reimbursement remains uncertain, many payers have agreed to keep most of the current policies in place through at least January 2021. At the same time, the list of services eligible for telehealth reimbursement continues to expand. On October 14, CMS further expanded their list with 11 new services, including those related to cardiac and pulmonary rehab programs.

The bottom line on the future of telehealth reimbursement

In the earlier months of the national pandemic, a senior member at a major healthcare organization shared with us an assessment with which many experts align: The future of telehealth regulation and reimbursement is likely to fall in between the lenient policies implemented due to COVID-19 and the restrictive policies that were in place just 12 months ago.

With the right telehealth platform, private practices can provide patients with better access to care and greater more flexibility, all while improving efficiencies and keeping patients engaged in their health in new ways. 

Also available:

Making telehealth part of your long-term practice plan

Telehealth for small and midsize private healthcare practices: Tips and resources

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