Telehealth Guidelines from CMS May Bring it to a Senior Near You

Older adults who are receiving benefits under Medicare for their healthcare needs visit the physician at least six times per year while most people visit four times a year. That number increases when blood draws, specialists, and procedures are added.

People over 65 also visit the emergency room 19.6 million times in one year (15% of the total visits) according to the Centers for Disease Control and Prevention (CDC) data.

Even with chronic disease management efforts such as medications, diet, and lifestyle factors, our senior loved ones will spend a lot of time in the hospital. They represent 40% of the total number of people hospitalized, according to Agency for Healthcare Research and Quality (AHRQ).

What can family caregivers do to reduce the frequency of doctor office visits and crisis care for senior loved ones?

Have you tried telemedicine or encouraged your senior to use this technology?

Using Telemedicine

Senior Care Corner has long been an advocate for the beneficial use of technology for seniors and their family caregivers.

The list of available and affordable technology can fill gaps for aging in place seniors and the caregivers who provide ongoing care and support.

One way seniors can use technology to improve their health and well-being is to begin using telemedicine services.

Telemedicine is healthcare using a technology that links people to all types of healthcare providers remotely (that is, not in the same location). It is defined as the remote diagnosis and treatment of a person using telecommunications technology.

CMS Changes for 2019

The Centers for Medicare and Medicaid Services (CMS) is the government agency that administers the Medicare Program.

Each year they determine how much and for what services they will reimburse healthcare providers across the spectrum. They also determine which benefits seniors will receive, such as for wellness visits or Part D prescriptions.

In 2019 the Fee Schedule for Physicians and Quality Payment Program is supposed to help boost support for telemedicine, which could help seniors wishing to participate.

Their own remarks show how valuable they now believe telemedicine can be for seniors:

“We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

By increasing the reimbursement rate for physicians, the theory is that more doctors will join in delivering telemedicine. The greater the participation by doctors, the greater the opportunity for seniors to access telemedicine.

Many doctors have been reluctant to offer telemedicine services to their patients because of several factors, including lack of tech knowledge, potential cost versus benefit of their time spent in electronic medicine, crossing state boundaries with licensure and credentialing issues, privacy concerns, and the inability to receive adequate reimbursement.

What Doctors Do Via Telemedicine

Doctors and healthcare providers of all types, including general medicine, mental health providers, nurse practitioners, specialists, and emergency providers can use telemedicine technology and many already are.

  1. Receiving vital signs via text message or smartphone apps, including blood pressure readings, daily weights, blood glucose levels, and respiratory oxygenation data, as well as other vital statistics that will help them manage chronic disease, adjust medication, and avert a crisis requiring emergency care.
  2. Communicating via text message to discuss concerns, symptoms, schedule appointments, pay bills, and refill prescriptions without needing an office visit.
  3. Reviewing records in the electronic medical record, especially test results or consultations (store-and-forward medical care).
  4. Completing virtual exams where symptoms or physical signs, such as rash or swelling, can be viewed electronically.
  5. Diagnosing and prescribing treatments, especially in emergency first aid situations, avoiding the need for ER visits. Many of these ‘virtual practices’ have been operational using smartphone apps for a number of years already.
  6. Providing education and health coaching to better manage chronic disease states.

What Are the 2019 Changes That Could be Game-Changers?

The new guidelines coming in 2019 which could signal more availability of telemedicine include:

  • Reducing the amount of time required to complete a “visit” remotely. In the past, healthcare providers had a minimum time that they must spend with each patient to qualify for reimbursement under Medicare. The current guideline of 30 minutes/month is reduced to 20 minutes/month. This time could be spent reviewing remote data, communicating with the patient or caregiver, or completing a virtual visit.
  • Reimbursing the provider for time spent setting up the equipment or teaching the patient or caregiver how to use it. The new guidelines establish payment for three individual steps — setting up equipment, on-boarding a new patient into their system, and then training the user on the technology. This is a big step forward in making telemedicine more accessible as it removes obstacles to initiation of the new technology for seniors and caregivers.
  • Clinical staff, not just the doctor and other qualified staff, will now be able to receive reimbursement for using telemedicine through the physician’s office. For example, if the receptionist uses telemedicine technology to schedule and bill, theoretically, this time could be added to the 20 minutes allotted per month to be billed. The medical assistant or nurse can review the vital signs sent daily and report critical values to the doctor for order changes without the doctor spending time reviewing data. This will free the doctor’s time for office visits while providing care and oversight for remote patients who won’t need to physically enter the office for routine monitoring. Even better, under the new guidelines, the doctor doesn’t have to be in the room (or building) where this monitoring occurs. Currently any billing for services provided using a qualified staff member under the supervision of a physician must have a doctor present in the same building at the time of services. This is a huge change and will likely encourage a new form of healthcare provision that will certainly benefit seniors.

The real time benefit for seniors and family caregivers could be game-changers.

Many experts believe that these new guidelines will encourage healthcare providers to get into the game and begin offering telemedicine. Some also believe this will signal new companies and start-ups who can leverage clinical staff to provide telehealth services under Medicare but have been unable to do so in the past.

Multitude of Benefits for Seniors and Caregivers

Just think about the many benefits that both seniors and caregivers can gain if they begin taking advantage of more telemedicine services.

Family caregivers won’t need to spend hours getting to and from routine appointments, making appointments, or getting seniors ready to go out, often for hours for a 15-minute appointment.

It may all but eliminate the need for fragile seniors to be transported to the doctor office for routine visits.

It can reduce the incidence of healthy seniors getting exposed to communicable diseases while they sit in the waiting room, not to mention a sick person spreading their illness to others. Imagine not needing a visit to be treated for flu symptoms.

This can mean less waiting time for those who need to physically visit the physician or healthcare provider if some things can be done remotely, such as blood pressure monitoring for medication adjustments and then prescription changes.

The ability to react quickly and get care remotely when a crisis is looming may prevent many emergency room visits and avoidable hospitalizations.

All of these benefits can help not only manage the health of our senior loved ones more effectively, but also reduce the cost of healthcare.

Telemedicine will not replace the need for seniors to visit a doctor in person at some point. In fact, the guidelines for telemedicine reimbursement often require that the senior be a current patient so that the initial visit will be made in person.

As the technology improves and the trust in the system increases, asynchronous healthcare via technology may not involve a face-to-face visit.

One thing is for sure, using telehealth will help seniors and caregivers when used now and in the future.