Okay, so … telehealth for Medicare patients. Currently, there’s payment parity, meaning a clinician gets paid the same amount for a Medicare patient visit regardless of whether that patient comes in the office or has a telehealth encounter. Right? Or did that end already? And if it didn’t end, how much longer will payment parity continue? Also, is it the same for commercial and Medicaid patients? Congress makes rules for Medicare patients, but is it Congress that makes the rules for commercial and/or Medicaid telehealth reimbursement rates? Or how do those reimbursement decisions get made?
What about the doing telehealth across state lines thing … the idea that if I’m a doc in New York, I can take a telehealth appointment with a patient in Arizona even though I am technically not licensed in Arizona? And who’s in charge of that?
Yeah, I went into today’s conversation with Josh LaRosa, VP at Wynne Health Group, with a lot of questions.
As you may suspect, this program is about telehealth. But just to level set on what we’re not talking about, this interview does not dissect the “should we use the telehealth or should we not” question; and it does not get into best practices or equity concerns. For that info, listen to the show with Christian Milaster (EP320) or Liliana Petrova (EP357) or Ali Ucar (EP362) or Ian Tong, MD (EP347).
Also, we are not talking about the politics, per se, of who’s for telehealth and who’s against it. We also aren’t drilling too far into the telehealth fraud cases that are coming to light right now, but of course we cannot resist talking about them a little bit.
So, let me tell you what Josh LaRosa and I are, in fact, talking about in this healthcare podcast. We’re specifically discussing the near-term future of CMS reimbursement for telehealth and the allowed so-called “flexibilities” for telehealth. We talk about a few of the why’s behind why are policy makers doing some of the stuff that they are doing. And then we chat about the when, how long some of the new flexibilities and reimbursements that were permitted originally during the pandemic will continue. We touch on the Cerebral incident (I guess maybe you’d call it) and the potential DEA or legislative actions that may result from that as well.
An interesting point that we dig into for a couple minutes is this one: Do not forget that the whole telehealth reimbursement debate (do I wanna call it?)—Should we cover it? Should we not cover it? And for how much?—this whole debate is part of a bigger debate. A much bigger debate, actually: the fee-for-service vs the not-fee-for-service debate. That’s the larger context of all of this, and I think it’s often overlooked.
Nobody anywhere is limiting how often a practice who wants to use telehealth as part of some kind of risk-based or capitated thing can use telehealth. Why? Because in a capitated or bundle arrangement, from a Medicare trust fund perspective at least, telehealth visits are not equivalent to additional spend or additional volume. In a non-FFS environment, there’s little chance of fraud also, really. Also, patient safety—arguably, probably—becomes much more of a practice concern. It gets a lot less rewarding to do unsafe things over telehealth when you don’t get automatically paid to do them … and also paid to fix the problems that resulted from the unsafe things, which is the perverse beauty of FFS that we’re all so familiar with.
Acronym alert! PHE stands for public health emergency. A public health emergency is the thing the government declares, for example, during a pandemic.
You can learn more at wynnehealth.com or by following on Twitter and LinkedIn.
Josh LaRosa, MPP, is a vice president at Wynne Health Group, focusing primarily on regulatory affairs with a focus on the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS). His interests lie in delivery reform and innovations in payment and care delivery models. Josh also supports the firm’s Public Option Institute, which studies the emergence of public option programs at the state level.
Prior to Wynne Health Group, Josh consulted for the CMS Innovation Center, where he worked to implement, monitor, and spread learning garnered from the center’s high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+).
Josh holds a Master of Public Policy from the University of Virginia’s Frank Batten School of Leadership and Public Policy. He also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA in political philosophy, policy, and law.
04:09 What is the story with telehealth policy right now?
06:08 What kind of flexibilities did HHS allow with telehealth after the pandemic?
09:46 Are we still under these pandemic flexibilities for telehealth?
12:15 Why isn’t the government just making greater access to telehealth permanent?
18:24 How does telehealth lend itself to the risk of overspending when dealing with an FFS model?
21:13 Does telehealth fit into the new CMS fee schedule?
22:55 How do states factor into the future of telehealth?
24:40 What is Arizona doing specifically to improve and ensure the future of telehealth?
30:56 What’s next in store for telehealth at the congressional level?