COVID-19: What healthcare leaders need to know about telehealth and the CMS policy changes Podcast - March 20, 2020 Government Programs Disaster Planning Quality & Patient Experience Patient Care Technology Sign in to save MGMA Staff Members MGMA is committed to providing expert resources, solutions and support to medical professionals as they deal with COVID-19. Experts agree that one of the most promising ways to keep patients and staff safe is through telehealth. Anders Gilberg, MGA, senior vice president, MGMA Government Affairs, recently joined the MGMA Insights podcast to explain how telehealth policy has been a priority for MGMA and the successes thus far in advocating for changes with the Centers for Medicare & Medicaid Services (CMS). Following the March 6 signing of the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (H.R. 6074), Department of Health & Human Services (HHS) Secretary Alex Azar was given authority to waive certain Medicare telehealth restrictions, effective for the duration of the COVID-19 public health emergency. “We don't want healthy, especially elderly, patients coming into the doctor's office, where they might be exposed to someone with the virus at a time when we can leverage technology and to provide the same services,” Gilberg noted, underscoring the need for expansion of telehealth capabilities. The following requirements for billing telehealth services through Medicare were waived, effective March 6, 2020: Geographic restrictions, permitting clinicians to furnish telehealth services to patients located in any geographic area [e.g., both non-rural and non-health professional shortage areas (HPSAs)]. Originating site restrictions, permitting clinicians to furnish services to patients in their homes. Telephone restrictions, meaning that telehealth services can be furnished via telephone or other qualifying device so long as the device has both audio and video capabilities. In addition, effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against healthcare providers who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype. That enforcement discretion is particularly important for practices that may not have the most up-to-date technology for telehealth services, Gilberg added, which should allow for more smartphone apps to be used, such as FaceTime, Skype, Zoom and others. “I think that that will help access especially when you have patients with multiple chronic conditions that may need to see a physician in this outbreak,” Gilberg said. “You have instances where you may have a patient who has symptoms that maybe are not critical, where then they can use the technology to talk to a provider, and to get an assessment with a safe distance and in the comfort of their own home.” Gilberg said MGMA will continue to advocate for telephone services, especially as they pertain to some elderly patients who may not have as much experience with smartphone apps and just want to talk to their physicians on the phone — and for physician practices to be reimbursed for this. “Our hope is that this opens the door for increased flexibility in the future,” Gilberg said. MGMA has supported enhancing access to care through new technologies and supports the CONNECT for Health Act, which would offer many of the same flexibilities for Medicare telehealth services beyond the end of the national emergency declaration. Medical practice leaders can find regular updates about policy changes related to COVID-19 in the MGMA COVID-19 Action Center, which Gilberg’s team in Washington, D.C., updates frequently. Guidance from CMS, the Centers for Disease Control & Prevention (CDC) and other government entities has evolved, so it’s best for practice leaders to stay up to date regarding the latest changes. Gilberg closed the conversation by emphasizing how impressed he and the rest of the MGMA staff have been by how MGMA members are responding to this unprecedented public health emergency, as noted by the vigorous discussions and shared stories in the MGMA Member Community. In addition to those digital resources, MGMA members are encouraged to reach out to MGMA Government Affairs staff with questions. “I know this is a stressful time for everyone in the healthcare community, and … we want to make your lives a little easier out there,” Gilberg said. COVID-19 resources MGMA COVID-19 Action Center — Regulatory and policy updates about the pandemic MGMA COVID-19 Resource Center — Articles, podcasts and more for the operational aspects of responding to COVID-19 Waived Medicare Telehealth Restrictions for COVID-19 — Free resource Additional resources in this series COVID-19 Update: An action plan for medical practices and healthcare professionals 'COVID-19 has pretty much taken over my life': A practice administrator's perspective COVID-19: How one of Northern California’s largest health systems is responding to the crisis COVID-19: Flattening the curve for America’s elderly patients through quarantine and isolation COVID-19: Did the healthcare system let down providers fighting on the front line? COVID-19: Keeping ‘a unified voice’ across a multispecialty clinic’s operations during the pandemic COVID-19: Practicing self-compassion and leadership under pressure during a crisis Executive Session: Protecting healthcare workers amid COVID-19 — “There is no room for error” Scalability of telehealth through simplicity Two leaders from Ingenium Digital Health also joined the episode to share their thoughts on responding to the pandemic with a focus on telehealth services: Christian Milaster, principal and digital health transformation advisor, and Kathy Letendre, organizational excellence advisor. “As you're hearing over and over from government officials the key is flattening this pandemic curve, and telehealth can play a role in that,” Letendre said. Milaster noted that he has worked to convince providers to embrace telehealth in recent years. “The technology really has been stable yet there has been a lot of hesitancy,” he noted. “Now providers see a really strong benefit for patients, to not exposing them to the risks when leaving their home, as well as a benefit to them of not exposing themselves to the patients, so they can continue to be there for the rest of the patients.” The work to simplify hardware and software for initiating telemedicine visits is a key element in making it more accessible for providers who now have clear motivation to implement new telehealth services. ”Administrators and the operational folks need to make sure that we have full systems in place so that providers can really focus on what they do best, and that is to provide care to diagnose and to treat patients,” Milaster added. As it relates to the potential for a surge of patient visits, shifting those visits from in-person visits to telehealth or virtual visits is about “relieving pressure” on a practice, Milaster said, who also added that phone services would be an important part of continuing to build upon live video services. “A lot of the triage is not about reimbursable care or about diagnosis — it's about making sure that we put each caller, each patient, each life into the right channel to get them the most adequate care that we can.” With any workflow, Milaster noted that scalability would come from simplicity. He recounted one organization had an average video connection time between provider and patient of 89 seconds. How did they allow for such swift visits? The video visit was preceded by an online questionnaire for patients to complete, allowing for more traditional triage work to be done before being presented to a provider. “If you have access to a system that has those features, that’s how you can very quickly scale” your telehealth services, Milaster said. However, Milaster cautioned that practice leaders understand that internet bandwidth may be strained for patients at home while their neighborhoods experience increased use of internet with families at home with schools and offices closed. In talking to practice leaders, Milaster noted that despite the federal waivers implemented, there are a number of limitations and considerations for telehealth with commercial payers, as well as navigating payments from state Medicaid programs and having a coding and billing staff understand the proper modifiers and locations to ensure successful claims paid. On top of the workflow, documentation and revenue cycle considerations, Letendre noted that practice leaders should think about identifying the distinct segments of their patient panels that might benefit greatly from remote care, such as patients who are sick or chronically ill with issues not related to COVID-19. Those patients getting care “at a distance,” she said, helps them avoid potential exposure from individuals who have been exposed but not yet in isolation or self-quarantine.