CMS Possible Reimbursement Changes – Telehealth

Angie Szumlinski Health, Studies

During the COVID-19 pandemic, visit volume at a sample of Federally Qualified Health Centers (FQHCs) declined modestly for primary care visits and remained stable for behavioral health visits because telehealth visits (particularly by telephone) replaced in-person visits. Few studies have differentiated between telehealth modalities. However, CMS estimated that 30% of telehealth visits were audio-only during the pandemic. Estimates reported may be higher because low-income patients face unique barriers to accessing video visits, and FQHCs lack resources to develop the necessary infrastructure. Study limitations include that only FQHCs in 1 state were tracked. Also, 5 FQHCs reported early challenges distinguishing visit types and categorized all telehealth visits by the dominant modality.

The rate of visits per 1000 patients was calculated by summing all visits each month across health centers and dividing by 1 731 326, which is the sum of all unique patients seen across all health centers in 2019. Primary care visits were defined as visits delivered by primary care clinicians including physicians (internal medicine, pediatrics, and family practice), nurse practitioners, and physician assistants. Behavioral health visits were defined as visits delivered by specialty behavioral health clinicians credentialed by the health center. For 2 participating health centers, in-person visit volume was imputed for February through April 2019; these data were missing due to changes in electronic health records.

Prior to the pandemic, many definitions of telehealth excluded telephone visits, and telephone visits were seldom reimbursed. Furthermore, CMS signaled it may stop reimbursing for telephone visits when the public health emergency ends. There are some concerns that telephone visits could result in fraud, abuse, and unnecessary and lower-quality care. Although these concerns are important to assess, eliminating coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of FQHCs to meet patient needs.

Bottom line, if you are allowing physicians to perform virtual/telehealth visits, be sure they are aware of the proposed changes to reimbursement! Stay the course, stay well, mask up, get vaccinated, and stay tuned!