The use of telehealth has literally been a lifesaver for delivering health care during the pandemic. Insurance companies and government bodies, like the Center for Medicare and Medicaid Services, have relaxed regulations that restricted the use of and payment for telehealth visits to enable health care providers to consult with patients remotely during a time when “shelter-in-place” guidelines were in place.
At medical groups across the nation, including Austin Regional Clinic, telehealth visits jumped from a few dozen a day to thousands a day.
Disadvantage to seniors
However, the regulatory changes left out one important option especially relevant to seniors: audio-only (telephone only) visits with patients who are in Medicare Advantage at-risk plans.
Many seniors are not adept at technology, do not have access to broadband to do video visits, or do not have smart phones or other technology to enable video visits. Using the telephone may be the only way they can connect with their physicians.
As I explained in MedPage Today, ARC is doing the best we can, as are physicians all over the country, to coach people on how to use their smartphone, or have their children come in and help them, but that's not always possible. The other issue is that there are people in rural areas, where there is not always good broadband, and it is technically impossible to make a video stream work.
Financial risk for medical groups
The other complication with excluding audio-only visits is financial, as I explained in an article in FierceHealthcare. Appropriate payment is still a major problem for physicians who are doing audio-only visits with patients in Medicare Advantage at-risk plans. They will be penalized because this information will not be considered in setting payment for these patients.
When a physician sees a patient with a Medicare Advantage plan, the notes on their diagnosis and conditions are recorded under a category called Hierarchical Condition Categories (HCC) or “HCC coding” for short. This information is used in a risk-adjustment model to estimate future health care costs for patients.
The data recorded in the HCC coding in effect determines what the physician practice will be paid on an annual basis, for the care of that patient, for the coming year. This payment covers not just physician care, but additional services patients with more chronic issues may need, like nurse navigators and high acuity triage nurses and doctors.
Not allowing the inclusion of audio-only visits means that the HCC data and other patient information is not used in setting these future payments. Especially for patients with complex health conditions, this situation could result in significant future losses if the visits and the diagnostic information is not included in payment calculations.
Potential negative impact on access to care
This is not a sustainable situation. It compounds the financial pressures now facing health care providers. Eventually, this underpayment may impact access to care and the cost of care.
Both the American Medical Group Association and America’s Physician Groups have also spoken out on the importance of including audio-only patient visits in available telehealth options. As of this writing, the exclusion is still an issue and discussions about it continue.