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Inside this Issue:
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President’s Message

The Board just completed their annual retreat and we have some new goals to bring MSHIMA forward as we strive to reach those we serve. Here is a quick run-down of those goals.
  1. To reach our student population and provide one speaker for each school program within the liaison’s geographic responsibility.
  2. The MSHIMA Board will develop a communication plan that reaches healthcare and state leaders to educate them on non-traditional HIM roles during the 2020-2021 Leadership year.
    • How will we do this: Explore alternative virtual options for educating counselors, outreaching to students, and growing knowledge of the HIM profession.
  3. Increase outreach to employers to better highlight programs and professionals. Possibly expand to a ‘community chat’ each month for sharing ideas, challenges, best practices, etc.
    • How will we do this: Board Members and liaisons will reach out to employers and speak to HIM Directors and Managers about their hiring challenges and ability to support the HIM profession
  4. The MSHIMA Board will create HIM promotional videos using students, teachers, and professionals during the 2020-2021 Leadership year.
  5. The MSHIMA Board will create a content channel on social media to distribute their promotional videos during the 2020-2021 Leadership year.
    • How will we do this: The Executive Director, through the management of our social media presence, will routinely post new content to improve engagement, knowledge and awareness of the association’s offerings
A common theme rang true throughout the retreat this year. We must improve our communication. One way to do this is to actively reach out to our constituents. This is not just our members, but also includes the organizations that employ, teach, and train those members. We have not adopted technology like many of our sister-CSA’s around the country and it has become imperative that we do so in the age of social distancing. We pulled off a virtual conference at the eleventh hour, but we need to learn from this experience and create an online presence that offers so much more throughout the entire year. As your president, I hope to personally visit many of the hospitals in our state to speak to HIM Directors and Managers. There is a considerable amount of possibility in what we can achieve with these new goals and I am excited to see where it takes us.


Kory Hudson, MBA, RHIA, CPHIMS
MSHIMA President
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Northeast Council Meeting for September

September 15, 2020
2:00 – 4:00 p.m. CDT


Click here for more information.
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VERISMA Offers MSHIMA Free Educational Webinars

MSHIMA is partnering with Verisma, a healthcare disclosure management company, to offer you five free educational webinars that will award you one continuing education credit hour per webinar. Thank you to Verisma for this service!
 
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CMS Offers Comprehensive Support for Louisiana and Texas with Hurricane Laura

On August 27, CMS announced efforts underway to support Louisiana and Texas in response to Hurricane Laura. On August 26, 2020, Department of Health and Human Services (HHS) Secretary Alex Azar declared public health emergencies (PHEs) in these states, retroactive to August 22, 2020 for the state of Louisiana and to August 23, 2020 for the state of Texas. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Laura.

CMS provided numerous waivers to health care providers during the current coronavirus disease 2019 (COVID-19) pandemic to meet the needs of beneficiaries and providers. The waivers already in place will be available to health care providers to use during the duration of the COVID-19 PHE determination timeframe and for the Hurricane Laura PHE. CMS may waive certain additional Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements, create special enrollment opportunities for individuals to access healthcare quickly, and take steps to ensure dialysis patients obtain critical life-saving services.

“Our thoughts are with everyone who is in the path of this powerful and dangerous hurricane and CMS is doing everything within its authority to provide assistance and relief to all who are affected,” said CMS Administrator Seema Verma. “We will partner and coordinate with state, federal, and local officials to make sure that in the midst of all of the uncertainty a natural disaster can bring, our beneficiaries will not have to worry about access to healthcare and other crucial life-saving and sustaining services they may need.”

Below are key administrative actions CMS will be taking in response to the PHEs declared in Louisiana and Texas: 

Waivers and Flexibilities for Hospitals and Other Healthcare Facilities: CMS has already waived many Medicare, Medicaid, and CHIP requirements for facilities. The CMS Dallas Survey & Enforcement Division, under the Survey Operations Group, will grant other provider-specific requests for specific types of hospitals and other facilities in Louisiana and Texas. These waivers, once issued, will help provide continued access to care for beneficiaries. For more information on the waivers CMS has granted, click here.

Special Enrollment Opportunities for Hurricane Victims: CMS will make available special enrollment periods for certain Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This gives people impacted by the hurricane the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange if eligible for the special enrollment period. For more information, please visit: Disaster Preparedness Toolkit for State Medicaid Agencies: CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, click here.

Dialysis Care: CMS is helping patients obtain access to critical life-saving services. The Kidney Community Emergency Response (KCER) program has been activated and is working with the End Stage Renal Disease (ESRD) Network, Network 13 – Louisiana, and Network 14 - Texas, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients and more.

The KCER is also assisting patients who evacuated ahead of the storm to receive dialysis services in the location to which they evacuated. Patients have been educated to have an emergency supply kit on hand including important personal, medical, and insurance information; contact information for their facility, the ESRD Network hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a waterproof bag. They have also been instructed to have supplies on hand to follow a three-day emergency diet. The ESRD Network 8 – Mississippi hotline is 1-800-638-8299, Network 13 – Louisiana hotline is 800-472-7139, the ESRD Network 14 - Texas hotline is 877-886-4435, and the KCER hotline is 866-901-3773. Additional information is available on the KCER website.

During the 2017 and 2018 hurricane seasons, CMS approved special purpose renal dialysis facilities in several states to furnish dialysis on a short-term basis at designated locations to serve ESRD patients under emergency circumstances in which there were limited dialysis resources or access-to-care problems due to the emergency circumstances. 

Medical equipment and supplies replacements: Under the COVD-19 waivers, CMS suspended certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the PHE. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance. 

Ensuring Access to Care in Medicare Advantage and Part D: During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.

Emergency Preparedness Requirements: Providers and suppliers are expected to have emergency preparedness programs based on an all-hazards approach. To assist in the understanding of the emergency preparedness requirements, CMS Central Office and the Regional Offices hosted two webinars in 2018 regarding Emergency Preparedness requirements and provider expectations. One was an all provider training on June 19, 2018 with more than 3,000 provider participants and the other an all-surveyor training on August 8, 2018. Both presentations covered the emergency preparedness final rule which included emergency power supply; 1135 waiver process; best practices and lessons learned from past disasters; and helpful resources and more. Both webinars are available here.

CMS also compiled a list of Frequently Asked Questions (FAQs) and useful national emergency preparedness resources to assist state Survey Agencies (SAs), their state, tribal, regional, local emergency management partners and health care providers to develop effective and robust emergency plans and tool kits to assure compliance with the emergency preparedness rules. The tools can be located at: CMS Regional Offices have provided specific emergency preparedness information to Medicare providers and suppliers through meetings, dialogue, and presentations. The regional offices also provide regular technical assistance in emergency preparedness to state agencies and staff, who, since November 2017, have been regularly surveying providers and suppliers for compliance with emergency preparedness regulations. 

Additional information on the emergency preparedness requirements can be found here.

CMS will continue to work with all geographic areas impacted by Hurricane Laura. We encourage beneficiaries and providers of healthcare services that have been impacted to seek help by visiting CMS’ emergency webpage (www.cms.gov/emergency).

For more information about the HHS PHE, please click here.

CMS Issues Medicaid Guidance for States on Implementing Interoperability Rule

doctor on a laptop while holding his stethoscope


A new federal regulation requires state Medicaid agencies to make it easy for patients to access their health information via smartphone by January 1.

To help with the heavy lift, the Centers for Medicare and Medicaid Services (CMS) issued guidance (PDF) Friday to help states implement the Interoperability and Patient Access final rule in Medicaid and the Children's Health Insurance Program (CHIP).

"The timeline for compliance with the CMS Interoperability and Patient Access final rule is aggressive, and CMS is committed to providing states with the necessary technical assistance to implement these advancements in improving patient access to their data and interoperability," said Calder Lynch, deputy administrator and director of the Center for Medicaid and CHIP Services in the guidance.

Lynch advised that states should seriously consider leveraging existing state and federal investments in health information exchanges (HIEs) to implement these new requirements.

The Department of Health and Human Services issued two major rules in March to implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act. 

The regulations require major changes for payers and hospitals to provide patients access to their health information.

Among other things, the rule requires that Medicaid, CHIP, Medicare Advantage (MA) plans and qualified health plans make enrollee data immediately accessible through a standards-based patient access application programming interface (API) by January 2021. 

That gives beneficiaries access to their claims and encounter information, including cost, through a third-party  mobile app of their choosing. 

Due to the COVID-19 pandemic, CMS said it won't enforce those requirements for an additional six months, which means enforcement begins July 1, 2021.

Medicaid managed care plans and CHIP managed care entities also will have to provide current provider directory information via an API by January 1, 2021. CMS enforcement will not begin until July.

Under the rule, Medicaid managed care plans and CHIP managed care entities must enable payer-to-payer data exchange so a beneficiary's health data can be transferred from one payer to another. That requirement goes into effect January 1, 2022.

The guidance outlines key steps that Medicaid agencies should take now to come into compliance with the interoperability rules, including:

  • Evaluate implementation guides developed by HHS and CMS to help implement the API policies;
  • Consider what contract amendments might need to be put in place with managed care plans and entities and what advance planning documents might be necessary;
  • Develop a project plan in coordination with the appropriate CMS Medicaid Enterprise System (MES) state officers to address funding and data infrastructure issues; and
  • Assess the organization's ability to create the appropriate data sets and the ability to send and receive that data.

HHS Extends Application Deadline for Medicaid Providers and Plans to Reopen Portal to Certain Medicare Providers

As part of its ongoing efforts to provide financial relief to healthcare providers impacted by the coronavirus disease 2019 (COVID-19), today the Department of Health and Human Services (HHS) is announcing an application deadline extension for the Phase 2 general distribution to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP) and dental providers. HHS also plans to allow certain Medicare providers who experienced challenges in the Phase 1 Medicare General Distribution application period a second opportunity to receive funding. Both groups will have until Friday, August 28, 2020 to apply.

"From the start, HHS's administration of the Provider Relief Fund has been focused on distributing funding in a way that is fast, fair and transparent," said HHS Secretary Alex Azar. "Extending the deadline for Medicaid providers and giving certain Medicare providers another shot at funding is another example of our work with providers to ensure as many as possible receive the support they need."

Medicaid, CHIP, & Dental (Phase 2 General Distribution) Deadline Extension

In June, HHS announced the opening of Phase 2 of the General Distribution – a $15 billion allocation – wherein eligible Medicaid, Medicaid managed care, CHIP and dental providers could begin applying for funding of up to 2 percent of reported revenue from patient care. The goal for this opportunity was to reach the remaining providers participating in state Medicaid and CHIP programs that did not receive funding in the Phase 1, Medicare General Distribution, as well as certain dental providers. Since the announcement, HHS has posted resources and hosted a number of webinars targeted at providers and provider organizations to answer questions and assist eligible providers with the application process. The initial deadline of July 20, 2020, was extended to August 3, 2020, based on provider feedback that they learned about the program too close to the deadline and needed more time to complete their application. HHS continues to keep an open line of communication with provider organizations, congressional, state and local leaders, in a collective effort to get the word out about this program, and HHS has learned that a second extension would be beneficial to those providers. By giving providers until August 28, 2020 to apply, HHS is hopeful it has struck the right balance in terms of providing as much flexibility as possible, recognizing the constraints on smaller practices already operating on thin margins with limited administrative staff. HHS will also soon be providing a more simplified application form in response to ongoing dialogue focused on improving the provider experience.

Second Chance for Certain Medicare Providers

Starting the week of August 10, HHS will allow Medicare providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution. In April, to expedite providers getting money as quickly as possible, as they faced the financial hardships stemming from suspended elective procedures and other COVID-19 related impacts, HHS, utilizing the Centers for Medicare and Medicare Services (CMS) payment information, distributed $30 billion directly to Medicare providers proportionate to their share of 2019 Medicare fee-for-service reimbursements. This was part one of the $50 billion Phase 1 Medicare General Distribution which sought to offer providers financial relief equal to 2 percent of their annual revenues. Providers that do not submit comprehensive cost reports with CMS were asked to submit revenue information to a portal to receive the balance of their 2 percent payment of General Distribution funds. Some providers, including many Medicaid, CHIP, and dental providers with low Medicare revenues, did not complete an application by the deadline for this additional $20 billion round of funding. HHS, in its principle of ensuring fairness in the administration of the Provider Relief Fund program, is now giving those eligible providers another opportunity to apply for additional funding. They will have until August 28, 2020, to complete an application to be considered for the balance of their additional funding up to 2 percent of their annual patient revenues.

Payments for Providers Who Had a Change in Ownership

As previously noted, HHS relied on 2019 CMS payment data on file to determine automatic payments for $30 billion of the $50 billion Phase 1 Medicare General Distribution. Accordingly, some providers or provider practices that experienced a change in ownership in 2020 missed out on payments as the payments were distributed to the previous owners. Prior owners are required to return the payments to HHS, if they cannot attest to providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020. For program integrity considerations, previous owners are precluded from transferring funds to new owners who may qualify and can attest to providing care for possible or actual COVID 19 cases. HHS did not reissue returned payments to the new owners and instead promised to give new owners a separate opportunity to apply for provider relief funding. That opportunity is now here. Starting the week of August 10, providers who experienced change in ownership challenges may submit their revenue information, along with documentation proving a change in ownership, by August 28 for consideration for Provider Relief Fund payment.

HHS is currently working to address relief payments to new providers in 2020 along with those that have yet to receive any funding for a variety of reasons, including the fact that they may only bill commercially, or do not directly bill for the services they provide under the Medicare and Medicaid programs and thus did not receive any funding yet. Future announcements will be provided.

For updated information and data on the Provider Relief Fund, click here.

Healthcare Groups Cheer House Move to Overturn Ban on Nationwide Patient Identifier

stethoscope on a computer keyboard

Healthcare and health IT groups are applauding federal lawmakers' efforts to help establish a unique patient identifier in U.S. healthcare.

Many health IT leaders see the investigation and creation of unique patient identifiers as critical to solving issues with patient matching and potentially minimizing misidentification and medical errors. And this effort is even more crucial amid a global health crisis, the groups say.

On Thursday, the U.S. House of Representatives passed the six-bill FY2021 minibus package that includes the Labor-Health and Human Services appropriations bill. As part of the bill, the House approved by voice vote the bipartisan Foster-Kelly Amendment, which strikes Section 510 of the Labor-HHS bill and removes the ban on using federal funding to create patient identifiers.

The long-standing ban has stifled innovation around patient identification issues and has prevented the Department of Health and Human Services from engaging the healthcare community to develop and advance a comprehensive nationwide patient matching strategy, according to healthcare leaders.

Reps. Bill Foster (D-IL) and Mike Kelly (R-PA) have led the efforts in the House of Representatives to remove the ban for the past two years.

Industry efforts to establish a unique patient identifier in U.S. healthcare hit a roadblock last year. A similar measure passed the House last year, but Senate appropriators failed to include language overturning the two-decade-old ban in the draft fiscal year 2020 funding bill for HHS.

"There has never been a clearer need to have accurate patient information. Filling in these critical gaps of data are essential to effectively respond to any public health crisis," said Joel White, Health Innovation Alliance (HIA) executive director in a statement.

"We applaud Representatives Foster and Kelly for their leadership in this effort and look forward to its full Congressional passage and implementation by the Administration." 

Striking Section 510 from the Labor-HHS appropriations bill will provide the HHS the ability to evaluate a full range of patient matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure and one that protects patient privacy, HIA said.

A healthcare coalition called Patient ID Now also cheered the House vote.

Failure to accurately identify patients to their data raises patient safety and quality of care concerns, and those concerns have been exacerbated during the COVID-19 pandemic, according to the coalition.

That group includes American College of Surgeons, the American Health Information Management Association (AHIMA), the College of Healthcare Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS), Intermountain Healthcare and Premier Healthcare Alliance. 

Accurate identification of patients is one of the most difficult operational issues during a public health emergency. Field hospitals and temporary testing sites intensify these challenges, and laboratories have reported difficulties returning COVID-19 results to the correct patients because of lack of comprehensive patient demographic data. Ensuring the correct patient medical history is accurately matched to the patient is critical for future patient care, patients’ long-term access to their complete health record, and for tracking the long-term effects of COVID-19, the Patient ID Now coalition said.

Hal Wolf, HIMSS CEO and president and CEO said House leaders' decisive action to eliminate the "outdated and harmful" appropriations ban on a unique patient identifier will permit HHS to actively engage in developing a national patient matching strategy.

"We encourage the Senate to include similar language in their appropriations bill, so the healthcare community can take action to advance patient safety through interoperable digital health information exchange," Wolf said.

A 2014 report from the Office of the National Coordinator for Health Information Technology (ONC) found that 7 out of every 100 patient records are mismatched. Worse still, the error rate is typically closer to 10% to 20% within a healthcare entity, and it rises to 50% to 60% when entities exchange with each other.

In a 2012 CHIME study, 20% of CHIME members could trace an adverse medical event to problems with patient identification and/or patient matching.

The lack of a consistent national strategy to accurately identify patients also exacerbates existing health inequities, healthcare leaders say.

Properly matching patients and their data not only improves care but saves resources, according to Patient ID Now.

The Ponemon Institute indicates that on average, 35% of all denied claims result directly from inaccurate patient identification or inaccurate and incomplete patient information, costing the average US healthcare system $1.2 million per year.

Last year, Sen. Rand Paul, R-Ky, advocated against overturning the funding ban.

Paul, who is a physician, said that the establishment of a national patient ID would jeopardize patient privacy by "centralizing some of Americans’ most personal information." 

Former Congressman Ron Paul, R-Texas, Sen. Paul's father, introduced language to the Labor-HHS appropriations bill in 1998 that put the original ban in place. 

Is Telemedicine Here to Stay?

The answer largely depends on whether Medicare and private health insurers will adequately cover virtual doctor visits once coronavirus outbreaks subside.
 
man looking out a window

Telemedicine is having its moment. Over the last few months, millions of people have relied on video or telephone calls to talk to their doctors. But as the pandemic moves across the United States, and eventually recedes in some places, how long will the moment last?

While patients used virtual visits to avoid overcrowded and potentially infectious doctor’s offices or emergency rooms, many are returning to face-to-face appointments in cities where the threat has subsided.

And insurance payments for telehealth services, especially at full cost, may only be temporary.

Medicare’s coverage of a broad range of services is slated to end when the coronavirus no longer poses a public health emergency. Private insurers, which followed the federal government’s lead, could revert to paying doctors for virtual visits at a fraction of the cost for traditional visits, if anything at all.

Some of the nation’s biggest insurers, like UnitedHealthcare and Anthem, say they haven’t decided beyond September or October on whether to extend the policies they adopted that allowed for coverage in lieu of doctors’ visits during the coronavirus crisis.

“The concern everyone in the industry has is that reimbursement is in jeopardy,” said Dr. Mia Levy, the director of the cancer center at Rush University Medical Center in Chicago, which treated patients virtually during the height of the pandemic. “Because of telehealth, we were able to stay actively engaged with our patients,” she said.

While there is broad bipartisan support for telehealth coverage, Congress would have to pass specific legislation to make some of Medicare’s changes permanent.

“Reversing course would be a mistake,” said Seema Verma, the administrator for the federal program, which reimbursed doctors the same for virtual visits, including those over the telephone, as for in-person ones and relaxed rules about who can use telemedicine.

About nine million people under traditional Medicare used telemedicine services during the early months of the crisis. Early data does not show wide variations in use by race or ethnicity.

“It was really a no-brainer for us,” Ms. Verma said.

And spending on telemedicine services during the first peak of the coronavirus pandemic in the United States underscores the demand. In addition to federal spending through Medicare, nearly $4 billion was billed nationally for telehealth visits during March and April, compared to less than $60 million for the same two months of 2019, according to FAIR Health, a nonprofit group that analyzes private health insurance claims.

But to convince insurers they should continue paying for virtual care, doctors must demonstrate they can move beyond treating simple respiratory infections to caring for patients with chronic conditions like depression or diabetes. “From the perspective of managing the cost and quality, there’s a lot we don’t know about telemedicine,” said Dr. Rahul Rajkumar, the chief medical officer at Blue Cross Blue Shield of North Carolina.

BlueCross BlueShield of Tennessee says it is the first major insurer to make coverage of telehealth services permanent, but it has not yet determined how much it will eventually pay for the care. A few insurers, including Cigna and the Blue Cross plan in North Carolina, said they will continue to cover telehealth services at pandemic levels through the end of the year.

“We need to give providers time to get more comfortable,” said Dr. Scott Josephs, the chief medical officer for Cigna. To make remote medicine successful and worthwhile, doctors and medical groups need to invest in technology and train staff. “If they don’t have the time, they won’t make the investments,” he said.
 
doctor performing telemedicine appts

The biggest hurdle to widespread adoption by both the government and insurers is the potential cost.

Lawmakers are reluctant to pass any bill that would significantly add to Medicare’s budget, with the government already spending a total of some $750 billion a year.

And private insurers see telemedicine as a way to save them money, said Sabrina Corlette, a research professor at Georgetown University, who helped author a recent report on how the companies responded to the pandemic. “Unless they are required to by the states or federal government, a lot of carriers will try to reimburse less for telehealth than an in-person visit,” she said.

For those at risk, telemedicine is particularly valuable. When a fever sent Susan Varak, 45, who has breast cancer, to the emergency room during the height of Chicago’s outbreak in April, she felt as if she were “walking into this war zone,” she said, because she was so terrified of catching the virus.

She appreciates she still can see her oncologist remotely. “I don’t think it’s absolutely necessary to be face-to-face every couple of weeks,” she said.

Other patients like the convenience. David Collins, 67, didn’t have a choice when he had a 20-minute video visit in March to rule out a diagnosis of coronavirus. Like many practices during the pandemic, the Kelsey-Seybold Clinic, a large physician group in Houston, was not allowing most patients to come in.

“I loved it because it saved me a lot of time.” he said, adding “I’d much rather do that than drive across town and look for parking.”

But, a few months later, he didn’t hesitate to go to the clinic for his checkup. “There’s a little more hands-on required,” he explained, like getting a physical exam and having his blood pressure taken. Not everything can be done virtually, he said. “If you break your arm, an e-visit isn’t going to help you at all,” he said.

After seeing about 90 percent of its patients virtually, Kelsey-Seybold has “almost flip-flopped back,” said Dr. Donnie Aga, an internist who oversees telehealth for the group. Most patients seem to prefer an in-person appointment. “You could really see that people missed coming in,” he said.

With coronavirus cases now at epidemic levels in Texas, the clinic wants to shift to dividing visits to half virtual, half in person. “You’ve got to have a balance, for sure,” Dr. Aga said.

But how doctors and insurers can do that is still unknown.

“We need to see where the equilibrium ends up,” said Dr. Andrea Gelzer, the corporate chief medical officer for AmeriHealth Caritas, a Medicaid managed care company. “If the total number of visits far exceeds pre-Covid, I don’t think that’s sustainable,” she said. Additional visits that do not improve patients’ health will only result in higher costs.
 
doctor leaning on a window as he looks off into the distance

Doctors have to be more discriminating about which patients to see remotely, said Rita Numerof, a health care consultant.

Telemedicine “was a solution to an immediate problem,” she said, and doctors did not have clear criteria about who should be seen, under what circumstances and for which conditions.

Many in Congress are already convinced that Medicare should continue the current coverage. “The Covid-19 pandemic has been a trial by fire, but the experience to date has made clear that the health care system is ready for broader access to telehealth on a permanent basis,” said Sen. Ron Wyden of Oregon, a Democrat who introduced legislation earlier this month.

On Thursday, Sen. Lamar Alexander of Tennessee, a Republican and chair of the Senate health committee, introduced the Telehealth Modernization Act, which would also make some changes permanent. The experience of the previous four months “will likely mean that hundreds of millions of physician-patient visits will be remote or online that were in-person before,” he said.

Since May, nearly 20 telemedicine bills have been brought to the House floor and about the same number in the Senate, said Miranda Franco, a senior policy adviser for the law firm Holland & Knight. She thinks legislation will be passed by the end of the year.

While some lawmakers favor permanently expanding Medicare payment for a broad range of telemedicine services, others are concerned about the technology’s cost and potential for fraud. “Now you’re talking about reimbursing services we haven’t reimbursed before,” Ms. Franco said.

Some patients say telemedicine is not a substitute for in-person care. Jorge Cueto, who is in his mid-20s, said a virtual visit is often an additional step before going to the doctor’s office for, say, a sore throat.

“It’s another fee, it’s another gating mechanism,” he said.

His parents, who are not fluent in English, prefer going to the doctor’s office because they find it easier to communicate in person, he said, and they have difficulty setting up video calls. “I don’t think they would be willing opt for telehealth if they weren’t required to do it,” Mr. Cueto said.

Others may not have access to a computer or smartphone to connect for video visits, and insurers are particularly wary of doctors charging for phone calls to follow up on lab results or tell someone to come to the office.

Even patients who have cellphones may not be able to afford a lengthy consultation, Dr. Levy said. She and her colleagues discovered some people stopped answering their phones at the end of the month because they had run out of minutes. “That was very eye-opening to us,” she said.

Some proponents argue the goal of telemedicine should not be to lower health care costs over all. One of its main benefits is improving patients’ access to care, said Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School, adding that it would be foolish to expect savings if more people also get treatment. “Those don’t reconcile,” he said.

Insurers should evaluate whether telemedicine is more effective for treating conditions like depression than it is for, say, cancer. They could then make those distinctions in reimbursing for virtual visits, he said, just as they do for different prescription drugs.

“There should be no single telemedicine policy,” Dr. Mehrotra said.
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