PracticalDermatology

Although it has been slowly evolving for years, telemedicine came of age during the COVID-19 pandemic. Much of this growth occurred because the US government relaxed restrictions around telehealth to help clinicians treat patients during the widespread shutdowns that closed offices.

In addition to pay parity for telemedicine visits, the federal government issued waivers that lifted geographical site restrictions to allow telehealth services to be delivered at any health care facility, in homes, and outside of rural areas. Moreover, waivers allowed doctors to reduce or eliminate cost-sharing for telehealth and audio-only telephone visits and still be compensated for the difference between these waived copays and the Medicare-allowed fee for services. Another waiver allowed physicians to provide telehealth services across state lines as long as they meet specific licensure requirements and conditions. All of these expansions enabled physicians to treat their patients and also helped many practices survive and keep their doors open during the pandemic closures.

In-person medical services fell by 23 percent in March 2020 and 52 percent in April 2020, and telemedicine services increased by more than 1,000 percent in March and more than 4,000 percent in April, according to a November 2020 study in JAMA Network Open.¹

Now that growing numbers of Americans are vaccinated against COVID-19 and states are opening up, more doctors are seeing patients for in-person care. The question that remains is which of these telehealth waivers should stay and which ones should go?

There is no set deadline for these decisions yet, as the waivers and flexibilities are tied to the Public Health Emergency status, and the Biden-Harris Administration is planning to maintain this status for the time being.

Still, many groups are weighing in about next steps. The American Medical Association and Federation for American Hospitals are pushing for increases in payments for telehealth services compared to pre-pandemic levels after the public health emergency is officially over. By way of background, pre-pandemic levels were just $15 for audio or video visits.

The Alliance of Community Health Plans suggests that pay parity for telemedicine continue for a transition period of five years. While pay parity may not be feasible in the long-term, near parity should be considered, many groups contend.

The argument against pay parity

On the flip side, MedPac, a group that advises Congress on Medicare, is arguing that while it’s important to keep some of the expansions in place temporarily, ultimately the government must revert to lower payments, as telehealth services are cheaper to provide than in-person care, and pay parity will encourage overutilization and lead doctors to favor telehealth visits over in-person services. What’s more, some payers contend that virtual visits do offer an opportunity for savings—and mandating pay parity could potentially counteract these potential savings.

All eyes are now on Congress. It could act to change the laws about which telehealth services Medicare will cover and instruct CMS to come up with fair rates.

My take? Unless Congress steps in and carves out telehealth from the rest of the Medicare fee schedule, reimbursement for telehealth services will drop as office visits contain practice expenses that just don’t apply to a phone or video call.

1. Whaley CM,et al. “Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic.” JAMA Network Open. 2020;3(11):e2024984.