Telehealth services accounted for a little more than a quarter of all medical visits to nursing homes covered by fee-for-service Medicare between March and June, according to the federal government’s top Medicare official.
The figure, noted in an essay by Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma, marks the first nursing home-specific estimate of telehealth utilization in long-term care in the wake of sweeping federal moves to relax restrictions around remote visits during the COVID-19 pandemic.
“Additionally, during the pandemic, CMS expanded the availability of telehealth services in other settings of care, including nursing homes, where beneficiaries may be particularly vulnerable,” Verma wrote in the piece, published last week in the journal HealthAffairs. “We found that 26% of beneficiaries who received nursing home visits did so by telehealth.”
Verma based that percentage on fee-for-service Medicare claims filed between March 17 and June 13, with “telehealth” classified as audio-only medical visits, virtual check-ins, and e-visits.
CMS made a series of moves to increase the use of telehealth in nursing homes during the COVID-19 crisis. Officials on March 17 announced a blanket waiver of rules surrounding telehealth in nursing homes and other settings; the Department of Health and Human Services (HHS) additionally signaled its intention not to pursue HIPAA violations for practitioners who use otherwise non-compliant platforms like Skype and FaceTime to conduct visits.
In late April, the government also allowed the provision of physical, occupational, and speech therapy services over telehealth platforms.
The demand, at least according to Verma, was quick and massive: During the last week of April, about 1.7 million FFS Medicare beneficiaries took advantage of telehealth services, compared with a typical average of 13,000 pre-pandemic.
The private insurance market has seen a similar explosion in telehealth uptake, with data non-profit FAIR Health finding an 8,000% increase in claims submitted to insurers during April alone.
Seniors dually eligible for Medicare and Medicaid, generally regarded as among the most vulnerable participants in the programs, had a higher rate of telehealth use than the general FFS population, with 34% taking advantage of the flexibilities — compared to 26% of all beneficiaries.
While Verma cautioned that the claims data remains incomplete, as providers can submit invoices for services up to 12 months from the time of the appointment, she used the numbers to emphasize her support for permanent expansion of some telehealth waivers post-pandemic.
“The early data show a dramatically accelerated adoption of telehealth in a matter of months, which warrants consideration of which telehealth flexibilities should become a permanent part of the Medicare program,” Verma wrote.
Many leaders in the post-acute and long-term care space have argued that the relaxation of rules was long overdue, and should remain a permanent part of operators’ arsenals moving forward; calls to remove the rural-only restrictions on nursing home telehealth care, for instance, have been circulating for years.
There’s also the simple reality that once patients and practitioners become accustomed to a service they like, it’s difficult for officials to roll it back.
“It’s kind of like toothpaste that’s now out of the tube,” Dr. Waseem Ghannam, the founder of the telemedicine company Telehealth Solution, told SNN in June. “It’s going to be really tough to put it back in.”
Ghannam isn’t alone.
“One of the things that is true with clinicians in the community that have not had the experience of telemedicine — I’m hearing from many of my colleagues they never want to go back,” Dr. Grace Terrell, CEO of the skilled nursing-focused physician group Eventus WholeHealth, told SNN in March. “They’re enjoying it.”
But Verma laid out a series of considerations that she believes CMS should take before making permanent any COVID-era telehealth flexibilities. For instance, the administrator argued that officials must weigh the benefits of in-person visits — “the gold standard” — against the telehealth upsides, erring on the side of what’s best for the patient.
In addition, Verma suggested that officials take a hard look at payment rates for telehealth services, acknowledging the lack of supply costs for virtual providers, as well as the potential for fraud and abuse.
“During these unprecedented times, telemedicine has proven to be a lifeline for health care providers and patients,” she concluded. “The rapid adoption of telemedicine among providers and patients has shown that telehealth is here to stay. CMS remains committed to ensuring that the government supports innovation in telehealth that leverages modern technology to enhance patient experience, providing more accessible care.”