President Trump signed the new Executive Order (EO) Improving Rural Health and Telehealth Access https://whitehouse.gov/news to further expand access to telehealth services during the COVID-19 pandemic, especially to rural communities. The EO is also extending certain telehealth services after the current public health emergency ends.
Some of the telehealth expansion builds on the work of CMS https://www.cms.gov during the public health emergency which more than doubled allowable telehealth services. Also, the Department of Veterans Affairs https://www.va.gov and DOD https://defense.gov have taken actions to expand telehealth services for veterans, active military, and their families. They are now allowed to use additional types of practitioners to provide telehealth services and use additional telecommunications applications.
Expanding and improving rural healthcare accessibility is important to rural residents, since today, rural patients might not have access to these services. To improve connectivity, the EO directs the FCC https://www.fcc.gov to work along with USDA https://www.usda.gov along with other executive departments and agencies to develop and implement a strategy to improve the physical and communications healthcare infrastructure in rural America. The plan is to launch a joint initiative in 30 days to improve the healthcare communication infrastructure and to expand rural healthcare services.
The EO is launching an innovative payment model to enable rural healthcare transformation. Within 30 days of the date of this order, the Secretary of HHS will announce a new model, to test innovative payment mechanisms to help rural healthcare providers provide the necessary level and quality of care. This model should give rural providers flexibilities from existing Medicare rules and establish predictable financial payments.
Within 30 days of the date of the EO, a report needs to be submitted to the President regarding existing and upcoming policy initiatives such as a) increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals, b) prevent disease and mortality by developing rural specific efforts to drive improved health outcomes, c) reduce maternal mortality and morbidity, and d) improve mental health in rural communities.
In addition, information from a new HHS report released July 2020 through the HHS Office of the Assistant Secretary for Planning and Evaluations, shows the trends of telehealth services for primary care delivery in FFS Medicare in the early days of the pandemic.
Analysts from Credit Suisse https://www.credit-suisse studied the HHS report as to telehealth usage among Medicare FFS Beneficiaries. The report concludes there is evidence that Medicare’s new telehealth flexibilities played a critical role in helping to maintain access to primary healthcare services when many beneficiaries and providers were concerned with transmission of COVID-19.
The analysts looked at the report’s discussion concerning telehealth usage in rural vs urban areas. It was noted that providers in rural counties saw smaller growth in telehealth visits in proportion to all primary care visits in March and April but saw smaller declines in May.
It was also noted that the data may under-represent the use of telehealth by rural patients since a rural patient can conduct a telehealth visit with a provider located in an urban area. However, the geographic location referenced in the report is based on the location of the provider delivering the consultation and not the beneficiary’s locations.
The analysts point out that in the 15 most populated urban areas, the level of telehealth usage varied from 38% of all primary care visits in Phoenix and all the way up to ~73% of visits in Boston. The thinking is that telehealth adoption although widespread does not appear to be correlated with just COVID-19 and the hope is to have continued interest in telehealth post-pandemic for millions of Medicare beneficiaries and healthcare providers.
Go to https://www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth for the HHS report.