Medicaid, Medicare and Telehealth: What the Pandemic Has Taught Us

By Kayla Matthews, freelance journalist, Productivity Bytes.

Kayla Matthews

As the coronavirus outbreak limits individual movement across the country, organizations are turning to remote solutions to stay operational.

As a result, demand for telehealth has skyrocketed — prompting health insurance payers, who haven’t always covered telehealth services, to reconsider coverage.

In April, the Centers for Medicare and Medicaid Services (CMS) made one of the most significant changes to Medicare/Medicaid coverage of the past few years. It announced it would expand coverage to more than 80 different telehealth services. Now, some insurers in the private sector are beginning to follow suit.

Here is how the pandemic is changing attitudes toward telehealth — and also the potential long-term impacts of coronavirus and telehealth service expansion.

Medicaid/Medicare and Telehealth Coverage Expansion

Many patients, wanting to reduce their chance of contracting or spreading COVID-19, are electing to avoid doctor’s offices. For some people — like the immuno-compromised and elderly — it’s no longer safe to have a checkup or routine visit. At the same time, many doctors have temporarily shut their practices and begun offering telehealth services to those who still need consultations and regular check-ins.

Others who have kept their practices open aren’t sure for how long it will be possible or responsible to do so.

The result has been an explosion in demand for telehealth services, as well as expanded offerings. Many of them, however, weren’t previously covered by Medicare or Medicaid, the public health programs that insure 34% of all Americans.

Early in April, the pressure pushed CMS to expand Medicare and Medicaid to cover 85 additional telehealth codes — including group psychotherapy, physical therapy evaluations and prosthetic training. The move came after Congress passed a coronavirus spending bill that included $500 million in telehealth coverage and several major private insurers announced they would waive copays for virtual doctor’s visits and other telehealth services.

Potential Impacts of Expanded Telehealth

The most immediate impact of the coverage expansion will be making medical services much more accessible. Current research shows that, while in-person visits are typically more effective, telehealth is great at expanding the availability of medical services. It may also help health care facilities reduce costs and improve patient satisfaction.

However, the changes to Medicare and Medicaid, and telehealth coverage expansion in the private insurance sector, is also likely to create a variety of extra challenges for clinicians and the health care system in general. The industry may not be fully prepared for them.

Telehealth services increase the amount of patient data that medical facilities collect and transfer. This data needs to be secured — otherwise, it’s vulnerable to hackers and cybercriminals. The expansion of telehealth will put medical cybersecurity front and center at a time when hospitals and other medical facilities are already facing a growing number of cyberattacks.

Others are concerned that expanding telehealth may increase the risk of Medicare fraud. Telemedicine has been used in the past by Medicare fraudsters as a way of dumping medical equipment on enrollees. Increased coverage for telehealth services may provide some extra room for criminals to take advantage of the system.

The Future for Telehealth in the U.S.

While we likely won’t see the impacts of this change for a few weeks or months, experts have a rough idea of how medical care will evolve. Access to health care is likely to improve, and patient satisfaction may increase as a result of the expansion of coverage. Hospital cybersecurity systems, however, will probably become even more important, and cybercriminals may take advantage of the data collected by telehealth systems.

It’s not clear if payers will continue to cover telehealth after the pandemic subsides. For the moment, demand for telemedicine is expected to continue growing over the next few months as practices remain closed and individuals limit their movement. Extra telehealth coverage will likely remain in place during this period.


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