US relaxes telemedicine rules as COVID-19 outbreak gathers pace

The US government has shaken up access to telemedicine services to make it easier for people to get advice remotely, without having to visit medical facilities overstretched by the COVID-19 pandemic.

Central to the changes is that the Medicare health insurance programme – which covers older people as well as younger patients with chronic health conditions – will temporarily reimburse virtual healthcare consultations at the same rate as in-person visits.

That removes a “disincentivisation that medical practitioners have previously faced”, according to Lux Research analyst Danielle Bradnan.

The Centers for Medicare & Medicaid Services (CMS) says the shift to more use of telemedicine will help people who need routine care – particularly the vulnerable – with access to healthcare services whilst limiting potential exposure to the virus.

The new waiver means that Medicare will foot the bill for “office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence” starting from 6 March and for the duration of the COVID-19 emergency.

Prior to the waiver, Medicare would only cover telehealth in certain circumstances, for example if the patient needing care lives in a designated rural area and they have a long-standing care relationship with their healthcare provider.

“Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly used services like FaceTime and Skype — a historic breakthrough,” said President Donald Trump at a press conference to announce the change.

“In addition, states have the authority to cover telehealth services for their medical patients,” he added. “We encourage everyone to maximise use of telehealth to limit exposure to the virus.”

The announcement represents a “monumental” shift in policy by the US government, said Bradnan. Meanwhile, there is speculation that it could lead to a longer lasting change in stance by the federal government after the coronavirus epidemic dies down if the shift yields the anticipated benefits.

“This comes at a time when it is critical to remove barriers to providing remote care in order to prevent the spread of COVID-19,” according to Bradnan.  

“These decentralised services are critical now, will retain their value, and because they are software-driven, are not at risk due to breaks in the supply chain,” she added.

There have been signs that CMS has been moving in this direction before the coronavirus outbreak.

Last year, it started to cover short patient-initiated communications with a healthcare practitioner, known as ‘virtual check-ins’, and also pays clinicians for ‘e-visits’ – non-face-to-face interactions through an online patient portal under Medicare Part B, which covers outpatient care.

The waiver extends to evaluation and management visits, mental health counselling and preventive health screenings “in all areas of the country in all settings,” according to CMS.

CMS Administrator Seema Verma said the new measures would allow around 62 million older citizens and people with underlying health conditions in the US to “talk to their doctor from the safety of their home.”

“This will help our healthcare providers focus on the people with the most dire need,” she added.