BOSTON (SHNS) – A top federal health official said Thursday she’s excited to see states moving to expand access to telehealth services and that she hopes Congress and private insurers will pursue similar goals.
Amid efforts to make it easier for people to virtually receive health care, Centers for Medicare and Medicaid Services Administrator Seema Verma held a videoconference with doctors and health care leaders from Massachusetts to delve into the ways telehealth has been deployed here during the COVID-19 pandemic.
“You all are the state with the highest utilization,” she told participants. “I think nearly 50 percent of the Medicare fee-for-service beneficiaries used telemedicine during the pandemic in your area.”
A March order from Gov. Charlie Baker required insurers to cover all medically necessary telehealth services and to reimburse providers at the same rate as in-person care during the COVID-19 emergency. That order landed as hospitals were trying to conserve their resources to treat a surge in COVID-19 patients and when many people were avoiding trips out of the house.
“We were delivering 800 telemedicine visits a week,” Massachusetts General Hospital’s Dr. Tim Ferris said of the status quo before the pandemic arrived. “We’re now delivering 8,000 telemedicine visits a day. I mean, that’s an extraordinary transformation.”
Verma’s roundtable came three days after President Trump issued an executive order aimed at increasing access to telehealth during the pandemic, particularly in rural communities, and extending availability of some telehealth services beyond the current crisis.
Verma said Trump indicated “his intent to try to make the telehealth benefit permanent inside the Medicare program.”
“Unfortunately we do need some help from Congress on this,” she said. “What Medicare can do is expand the number of services that are allowed to be paid under the telehealth benefit, but it would require Congress to be able to allow this to occur outside of rural areas to be able to be performed in somebody’s home. So, let’s all keep our fingers crossed that they’ll allow us to do that.”
Verma said Medicare officials are having discussions about the parameters that should be in place around telehealth visits, including what types of services the technology is appropriate for and the care settings where it can be used effectively.
“I just got an email from some of the insurance companies that said they’re following what Medicare is doing on telehealth, and I’m hoping that the private insurers will take our lead, or at least strongly consider making this permanent, because I think if it’s just a couple of payers, providers may not want to continue to make the investment,” she said.
Both branches of the state Legislature have passed bills that aim to cement telehealth’s place in the health care landscape in Massachusetts, and those bills are before a House-Senate conference committee led by House Majority Leader Ron Mariano and Sen. Cindy Friedman.
Both bills (S 2796, H 4916) would allow insurance coverage for audio-only telehealth calls, instead of just calls that use video.
Dr. Leonard Finn, a family medicine physician affiliated with Newton-Wellesley Hospital, said telehealth can be “immensely convenient and time-efficient.”
He said while it would be “really taxing” to tell a patient to come into the office every two or three days, it’s easier to have a ten to 20 minute telehealth visit at that same frequency. The quality of technology available to patients can become an issue, though, Finn said.
“I’ll make a plug for, we should be getting payment for the telephone part, because elderly, frail patients sometimes don’t have the technology, and we’re still doing the serious work with them,” he said. “We also need to upgrade the technology in general because some people don’t have good computers and some people don’t have good Wi-Fi.”
Verma said the potential for telephone visits is an issue “we continue to grapple with.”
“I think it makes sense, especially with established patients,” she said. “I think where there’s concern is, do we create a industry of fraud where there’s just robo-calls, you know. So it’s kind of thinking through what are the parameters that you put around that.”
Finn said it would be difficult to treat a new patient over the phone, but with patients he’s known for decades, he’d be able to “judge pretty clearly” how they are reacting based on the tone of their voice.
Barbra Rabson, the president of Massachusetts Health Quality Partners, said many patients find a “tremendous benefit” in virtual care, particularly for mental health services. She said the effectiveness depends not just on a patient’s comfort level with telehealth but also how comfortable any particular clinician is with the pivot from traditional in-person care.
“We need to learn more about what circumstances give people more comfort and who does a better job and is more comfortable providing these services,” she said.