The government shutdown, for the first time, has halted flexibilities for telehealth for Medicare beneficiaries that had been established since the peak of the COVID-19 pandemic.
Now, some offices are no longer offering telehealth services, and as a result, some patients must travel to a medical office to receive these services. It also stalled the Acute Hospital Care at Home program, which allowed hospitals approved by the Centers for Medicare and Medicaid Services (CMS) to furnish inpatient-level hospital care for Medicare and Medicaid fee-for-service beneficiaries in their homes via telehealth, remote monitoring and other means
Journalists can find a wealth of story ideas about how this is impacting patients, providers and hospital systems during this unprecedented time. See my suggestions further down in this post.
How long could the shutdown last?
The shutdown could last anywhere from another few days to a few weeks, Alexis Apple, director of federal affairs for the American Telemedicine Association, told AHCJ.
“I think we’re really going to feel the pain on this one,” said Apple, who is also senior manager of federal government relations for ATA Action, the organization’s advocacy arm. “The House [of Representatives] isn’t even in session this week, and the Senate is doing its fifth vote on the Continuing Resolution, and they don’t expect that to get passed, so I think it’s going to be a while.”
ATA member organizations, including hospital systems and virtual-only companies, are taking multiple approaches to providing telehealth during the shutdown, she said. Some have said they will continue to provide telehealth to Medicare beneficiaries and hope to be reimbursed retroactively once the shutdown ends. Others are more hesitant and have already cut off services as of 12:01 a.m. on Oct. 1, saying they couldn’t take the financial risk. Still more said they’re going to take it day by day to see how long the shutdown will last.
“It’s really all over the place,” Apple said. “The longer it goes on, I expect more members to cut off services, unfortunately.”
The ATA and others had supported and endorsed a temporary extension to cover these services through Nov. 21, which was proposed in the U.S. House of Representatives, Healthcare IT News reported. But no legislation was passed by Sept. 30.
How are these services impacted by the shutdown?
Regarding telehealth, here are some key differences for Medicare beneficiaries as of Oct. 1, according to a blog post from Epstein Becker Green law firm:
- Medicare is no longer reimbursing telehealth visits for patients outside of an approved originating site, such as a doctor’s office, or outside of certain geographic areas, meaning beneficiaries are not eligible to get reimbursable telehealth services in their homes.
- Physical and occupational therapists, speech-language pathologists and audiologists are no longer eligible to provide reimbursable telehealth services to Medicare beneficiaries.
- Medicare is now requiring in-person visits within six months before an initial telehealth visit for mental health care, and every 12 months after.
- Audio-only visits are no longer reimbursable except in limited circumstances where the patient cannot or will not use video, but where the provider is capable of using audio-video technology.
- Telehealth can no longer be used to conduct face-to-face encounters required for recertification of eligibility for hospice care.
- Telehealth services were also extended to federally qualified health centers and rural health clinics. Clinicians in those settings can still provide mental health visits through real-time audio and video telecommunications. They can also continue to use telecommunications to provide medical visits through Dec. 31, 2025.
Telehealth has become a vital service for many patients, particularly those who are elderly and/or have limited mobility, the Washington Post reported. More than 6.7 million seniors — a quarter of eligible Medicare beneficiaries — received care through a telehealth service visit last year, the article said, citing CMS statistics. Those living in rural locations may now have to pay out of pocket or spend hours in the car traveling to a clinic for appointments, depending on what their providers are doing in the interim.
Hospital at home on hiatus
CMS sent guidance to hospitals participating in the Acute Hospital Care at Home program that all patients had to be discharged from the programs or returned to the hospital as of midnight Sept. 30, STAT reported. More than 400 hospitals across 147 health systems in 39 states secured waivers to provide hospital-at-home programs, the article noted. About 31,000 seniors used the program as of last October, the Washington Post noted, citing CMS statistics.
Some hospitals stopped admitting patients to their hospital-at-home programs a few days earlier, anticipating a shutdown, according to another STAT article. For example, Hackensack Meridian Health in New Jersey stopped admitting patients as of Sept. 26. ChristianaCare in Delaware stopped admitting Medicare patients over the weekend before Sept. 30, but continued to admit patients covered by other insurers, depending on their coverage. Mass General Brigham in Boston began reducing its census in the days leading up to Oct. 1.
CMS had released guidance in September stating the agency was no longer accepting applications for the program, Apple said, and that there would be a 60-day non-enforcement policy for patients admitted prior to the Sept. 30 deadline, most likely due to the shutdown. It’s unclear what that will look like in practice, she said.
What happens next?
It is expected that the Medicare telehealth flexibilities and Acute Hospital Care at Home program will be reinstated once the shutdown ends, Apple said: “Whatever continuing resolution is passed, it’s going to have to look a little bit different than what it did a few weeks ago, because it’s going to have to have a new statement saying to reinstate these provisions, and then also to retroactively reimburse for these provisions.”
“I think members of Congress are really going to hear from constituents, providers and patients, and I think that they will act, whether it’s a longer-term extension next time or permanency,” Apple said.
Previously, legislation covering these programs had been subject to an “endless merry-go-round of short-term extensions,” Kyle Zebley, senior vice president of public policy for ATA and executive director of ATA Action, told AHCJ in the spring.
Story ideas
Here are a few story ideas to get you started.
- Talk to hospitals that had been providing hospital-at-home care or patients receiving that care who had to go back to the hospital. How did hospitals find beds for them? How has this impacted clinical team workflows and the quality of life for patients?
- Chat with Medicare beneficiaries who can no longer receive telehealth services or physicians who can no longer be reimbursed for these services. How are they handling the transition? What about people in rural areas who live far from medical clinics?
- Interview congressional members who have been proponents of telehealth and hospital-at-home care about how these programs could be reinstated.
- Contact telehealth and remote monitoring companies to find out how their businesses have been impacted.
- Follow what’s happening on Capitol Hill to look for any new continuing resolutions aiming to reinstate these services.
Resources
- Plunging Over the Telehealth Cliff: Now What? – a blog post from Epstein Becker Green law firm
- Millions of seniors lose access to telehealth services in wake of shutdown – PBS News
- Millions of seniors could lose access to telehealth without deal in Congress – Washington Post
- Patients and providers face telehealth cliff as government shutdown begins – Healthcare IT News
- Patients set to lose hospital care at home if government funding isn’t extended – STAT
- Home hospital programs in ‘terror’ as they grind to halt ahead of government shutdown – STAT
- What the shutdown means for Medicare, Medicaid and other health programs – NBC News
- Telehealth for Medicare beneficiaries gets another reprieve – an AHCJ blog post
- Telehealth on the line: What could happen this spring? – an AHCJ webinar
