Heritage Recommendations Influence Administration’s Telemedicine Guidance


Heritage Recommendations Influence Administration’s Telemedicine Guidance

April 24th, 2020

This method of health care delivery offers obvious advantages, allowing patients to get personal medical advice quickly, without having to come to the doctor’s office first. Getty Images / valentinrussanov

Long before COVID-19, The Heritage Foundation recommended more Americans have greater access to telehealth.

When the Republican Study Committee released its health reform plan last October, the group included recommendations from Heritage health policy scholars to remove federal barriers that halt widespread use of innovative health care solutions such as telehealth.

The Trump administration has also made telehealth a priority, reflecting Heritage proposals, and amplified those efforts in response to COVID-19.

“The administration, Congress and some states have rightly removed barriers that prevented patients from receiving access to care through telemedicine.This helps with battling COVID-19 and could have even bigger implications for how patients access health care in the future," said Marie Fishpaw, director of Heritage's Domestic Policy Studies. "Doctors and patients have responded to this relief, with telemedicine use up sharply. Policymakers should build on this relief, make it permanent and remove additional barriers."
In battling the pandemic, these Heritage recommendations were initiated under emergency orders and codified in the CARES Act:

Allow greater access to telehealth through high deductible plans and health savings accounts. Allowing telehealth services to be “preventive care” for high deductible health plans and services during this crisis allows patients to have access to video-conferencing and telehealth to talk with health care providers. This helps patients talk with providers without going to a physical office and risk potential exposure to the virus—without incurring deductible costs.

Reimburse telehealth visits like in-person office visits. Heritage recommended that federal and state efforts should focus on removing any financial incentives that advantage in-person visits more than telemedicine visits. Not only did the Centers for Medicare and Medicaid Services declare that telehealth visits are considered the same as in-person visits, but Missouri instructed its Department of Social Services to reimburse health care providers for telehealth services under the same standard of care as in-person services.

Bundle telemedicine activities in pre-existing Current Procedural Terminology (CPT) codes. Medicare and Medicaid’s reimbursement policies made it hard for beneficiaries to use telemedicine. Heritage suggested that policymakers bundle telemedicine activities in current CPT codes instead of proposing additional codes. This not only reduces billing and coding burdens but it also gives doctors the flexibility to determine which telemedicine options are appropriate for an individual patient throughout treatment. This change was adopted by the federal government for Medicare and by some states for Medicaid and privately insured patients for the duration of the emergency.

Outline guidance for what constitutes telehealth. The definition of telemedicine varies widely from state to state and among licensure boards. This is difficult for in-state practitioners as well as out-of-state telehealth companies that can provide telemedicine to rural patients. Heritage urged policymakers to ensure that the definitions surrounding telemedicine were broad enough to facilitate innovation while protecting patients from unsafe or inadequate services. The Centers for Medicare and Medicaid Services outlined those telehealth services that met its standards to ease the use of high-quality and safe telemedicine services during this crisis.

Allow physicians licensed in one state to practice in the rest of America. Licensing is different from state to state and this inhibits physicians and providers from helping out-of-state patients. Heritage encouraged state policymakers to consider ways to ease licensure rules to allow providers licensed in one state to practice telemedicine across state lines. The Centers for Medicare and Medicaid Services temporarily waived Medicare and Medicaid requirements that physicians and non-physician practitioners be licensed in the state where they are providing services, allowing out-of-state providers to remotely help patients in areas highly impacted by the outbreak.

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