‘The genie’s out of the bottle on this one’: Seema Verma hints at the future of telehealth for CMS beneficiaries

When the COVID-19 pandemic began and it became clear telehealth would be necessary for physicians and nurses to treat patients remotely, CMS boosted rates for telehealth visits so they matched rates for in-clinic visits and would sustain providers during the pandemic.

CMS also relaxed its guidelines about the type of telehealth visits it would cover, making them accessible to nearly all beneficiaries and situations. Health systems pivoted to virtual visits for primary care and non-emergent visits as well as check-ins for patients with chronic conditions. Private payers followed suit and many updated their coverage guidelines and rates through this summer.

During the early weeks of the pandemic, health systems including St. Louis-based Ascension and Chicago-based CommonSpirit Health reported huge increases in telehealth visits, according to the Wall Street Journal. The increased availability and coverage for telehealth visits have been crucial in the adoption by providers and patients, and now both are becoming comfortable with telehealth visits; many in the industry predict that telehealth is here to stay.

But what about the policies that made it possible?

Both CMS and private payers currently have an expiration date on their enhanced telehealth coverage post-pandemic. Before COVID-19, CMS only covered telehealth visits in certain situations and most beneficiaries didn’t have access to it. The coverage rates from both public and private payers were typically much lower than in-person visits at practices or hospital-based clinics. The coverage was a roadblock for adoption for some healthcare providers.

The Wall Street Journal reported that CMS telehealth visits went from 100,000 per week to 300,000 per week as of March 28, and the agency expects that to increase.

“I think the genie’s out of the bottle on this one,” Seema Verma, the CMS administrator, said. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

If the telehealth coverage is relaxed and payments are increased, there is some concern about over-utilization. 

While CMS has not made any permanent updates for telehealth yet, Ms. Verma did call telehealth a “clear example of untapped innovation.”