By Susan Saldibar

Have you used telehealth during the pandemic? I did, twice. It was great. I didn’t have to shlep to a crowded waiting room and freak out if my allergy cough acted up. Telehealth is another “good thing” that came out of the horrors of the pandemic. And it would appear that it’s here to stay. 

Or is it?

The PHE (Public Health Emergency) declaration, which opened the doors for Medicare-reimbursed telehealth-delivered therapy is set to expire this fall. And it’s creating what many now refer to as a “telehealth cliff” for Medicare beneficiaries, especially in long-term care and among those who have grown comfortable with virtual care for physical, occupational, or speech therapy. (And, yes, that’s possible – more about that later).

Mark Besch, Chief Clinical Officer for Aegis Therapies (a Foresight partner) weighed in recently on the PHE and why he feels it is a major advantage for providers and recipients that needs to be continued. 

The Skinny on Telehealth

First, here’s what it’s all about:

  • Prior to COVID and the PHE declaration, there were no PT/OT/ST codes listed by CMS as approved to be provided through telehealth sessions, so they could not be reimbursed by Medicare.
  • Prior to COVID and the PHE declaration, the list of clinicians eligible to deliver care via telehealth did not include therapists nor therapy assistants. 
  • The PHE provided a waiver to add the codes necessary for reimbursement. It also allowed CMS to add therapists and assistants to the approved list.
  • The PHE enabled therapy sessions to be provided to more people. (Aegis went from providing an estimated 97 telehealth visits in June, 2020 to 2300 telehealth visits by December, 2020!)

And, telehealth therapy works. As Mark explains it, each visit is facilitated by an on-site trained therapy assistant or other caregiver who sits with the resident and is guided by the remote therapist. It enables a highly trained therapist to provide timely care for residents who, otherwise, could be waiting for an appointment that might be delayed considerably due to staffing shortages or restrictions on staff entering facilities due to infection control.

In the CY2022 Physician Fee Schedule proposed rule, CMS has indicated the codes associated with telehealth therapy could at least temporarily remain on the list of approved codes through the end of calendar 2023. However, Mark is concerned that the waiver that put therapists and assistants on the list of eligible clinicians still stands to expire when the PHE declaration expires. That part will apparently require Congress to act.

Clear Benefits

So, like so many things these days, it’s complicated. But that shouldn’t stand in the way of taking actions to move legislation forward and keep this issue in front of Congress. There are clear benefits to making the PHE adjustments permanent, Mark says. To name a few key ones:

  • Allows therapists to interact with and “touch” patients who would otherwise have to wait for care until therapists could come back into the building. Now, with the Delta variant, that could remain an issue for quite some time.
  • Enables more timely visits.
  • Helps augment staffing shortages by allowing fewer therapists to actually cover more ground. “Some therapists are tired of it all, stressed out by working with known COVID-positive people all day,” Mark says. “They’re saying ‘I’m out’.” Telehealth reduces travel and may help retain therapists.
  • More coverage, more visits bring the potential for better outcomes as well.

Major Players Are on Board

According to Mark, an increasing number of managed care providers are already on board, including major players like Aetna and Cigna. “They recognize the benefit,” he says. “They are saying they’ll pay for telehealth with no stated time limit – both companies indicate ‘until further notice’. So, they’re actually ahead of CMS on this.” So are the skilled nursing facilities who, Mark says, “100% understand the benefits and support telehealth therapy.”

Who’s against it? Other than the usual pushback of granting blanket approval and quality concerns, most providers and beneficiaries are nodding their heads in agreement, Mark says. And they understand that, even after COVID subsides, telehealth therapy can continue to bring benefits to skilled nursing and home health alike.

Make Some Noise at the Grassroots Level

So now, Mark says, it’s a matter of putting a spotlight on the issues and keeping the pressure up. “We need to be advocates, especially at the grassroots level,” Mark says. “While it’s important for nationally recognized associations like AHCA and NASL to come out in support of extending the PHE waivers, what will make the difference is for Congress to hear from thousands of their constituents.”

Mark believes, with the help of a grassroots effort, a telehealth bill, in some form will pass. The question is how much of the therapy piece will remain intact.

You can learn more about the telehealth “cliff” and sign up to be a part of Aegis’ advocacy campaigns here.