Many Medicare patients can’t get telehealth during the shutdown : Shots

Telehealth – seeing a doctor or nurse via video conference on your phone or computer – has seen a boom during the pandemic. Telehealth payments for people with Medicare are suspended during the shutdown.

Photography by eLuVe/Moment RF/Getty Images

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Photography by eLuVe/Moment RF/Getty Images

A few weeks ago, when Vicki Stearn, 68, tried to schedule a virtual visit with her doctor, she was told that Medicare — at least temporarily — stopped paying for telehealth appointments when the government shut down. So Stearn was offered a choice: make an in-person appointment or pay out of pocket for telehealth.

“So I said, ‘OK, well, when can I get an in-person appointment?’ And that wouldn’t have been possible before December.”

So Stearn, who lives in Bethesda, Maryland, paid — hoping that when the government reopens, she’ll be reimbursed. But Stearn, who serves on Johns Hopkins Medicine’s patient advisory board, says the loss of telehealth services makes life difficult for almost everyone — from the worker to Stearn’s own 90-year-old mother, who hates going to and from the doctor.

“When I have a cold, do you really want me to go to the doctor and talk to everyone?” Strearn said. “There are so many different reasons why telehealth is a good idea.”

“A continuing disaster for access”

The use of telehealth in Medicare began in earnest during the pandemic and quickly became popular. Nearly 7 million people with Medicare use telehealth services each year to see their doctors, but the federal shutdown abruptly halted payments covering these services. Specifically, temporary pandemic benefits, which were renewed several times to allow payments, could no longer be reauthorized. Without this administrative approval, Medicare patients – and their doctors – find themselves in a very complicated and confusing limbo.

“It’s a continuing disaster in terms of access,” says Kyle Zebley, senior vice president of public policy at the American Telemedicine Association.

Even large hospital systems, he says, don’t have a significant financial cushion to be able to continue offering services without government reimbursement. Additionally, there is no clear indication that providers will be reimbursed for telehealth services during the shutdown.

Hundreds of hospitals across the country have also suspended investments in what are often called “hospital at home” programs, which provide more sophisticated remote monitoring and care allowing patients with more serious illnesses to stay at home. Zebley says these patients have been released or admitted to the hospital if they need continued care.

Zebley says this temporary shutdown of telehealth services is particularly frustrating because it East should come back, eventually, and then hopefully become permanent. It’s practical, effective and appreciated equally across the political spectrum, he says. “There is broad bipartisan support from the leftmost member of the Democratic caucus, the rightmost member of the Republican caucus – no one is anything other than universally in favor of maintaining these services. And yet here we are.”

Different ways to handle interruption

In the meantime, doctors’ offices and hospitals must decide: Do they continue to offer services, float costs and hope to recoup Medicare payments later? Or, are they interrupting services and forcing patients to come in, potentially causing a delay in appointments and forcing patients in rural areas to travel long distances?

Helen Hughes, a pediatrician and director of telehealth services at Johns Hopkins, says each Medicare provider she’s spoken with seems to take a slightly different approach.

During the first two weeks of closure, the Hopkins network of hospitals and clinicians continued to offer previously scheduled telehealth appointments. They have, however, delayed billing Medicare, hoping to be reimbursed once the shutdown ends. “Our clinicians charge a fee to our electronic health record, but we don’t send it to Medicare,” says Hughes.

But as the shutdown dragged on and unpaid charges piled up, Hughes and the hospital system changed course. On October 16, they informed Medicare patients to schedule any further in-person visits.

Hughes says that, unfortunately, many of those called back into doctors’ offices are cancer patients or people who have received neurological treatments – conditions for which driving can pose real challenges and physical strain.

And pausing telehealth isn’t as simple as turning a switch on or off, Hughes says. In the years since the pandemic, Johns Hopkins has set up a centralized center of about 16 doctors who all work remotely and therefore can see patients for longer hours, more days per week and larger numbers of patients, even in rural areas.

This team has continued to work since it also receives patients benefiting from private health insurance.

But Hughes worries that stopping telehealth for Medicare could stall progress, saying that “in this confusing environment” when patients are trying “to access this type of care, and not succeeding…we can lose credibility that this is a stable type of care.”