Policy in Plainer English

Our second episode on Telehealth Reimbursement during COVID-19 looks at the systems used to set payment for telemedicine services.

If you want more details on evolving Medicare telehealth billing guidance in response to COVID-19, see this video from CMS, updated on May 8th

If you want lots of details on Medicare billing as it relates to FQHCs, visit the Bi-State Medicare Guidance page, which is regularly updated and contains links to key CMS documents.

If you want to fact check the claim that this is the worst public health disaster since the advent of the modern telephone system, check out this Fast Company article on the telephone system that was in place during the 1918 Spanish flu and which, unfortunately, relied on an army of operators to manually make phone connections.

Thank you to Northern Counties Health Care for their sponsorship of this special series on telehealth and COVID-19.

This episode tackles broadband deployment in Vermont and telehealth in approximately ten minutes. . . obviously, we don't include everything. Below are some links to help you learn more. We thank Clay Purvis and Rob Fish of the Vermont Department of Public Service for being generous with their time on this topic, and Northern Counties Health Care for sponsoring this special series on telehealth during COVID-19. 

• Overview of what we mean by "high speed" (or any speed) Internet
• Dept of Public Service (PSD) Broadband Availability Maps
• PSD Guide to Connectivity Resources in COVID-19
• PSD Guide to Connecting for Telehealth / Distant Learning (maximizing the speed in your house at any given time)
• Public Wi-Fi Hotspots in Vermont
• Overview of Federal Funding Opportunities for Connectivity (prepared by the Vermont Legislative Council on May 6th) 
• National Telehealth Technology Assessment Resource Center (where to go to find out about the tech side of telehealth)

May 29 Update: Apparently we aren't the only podcast covering broadband access in rural America during COIVD-19, check out this latest episode from Planet Money. 

In an epilogue to the Telehealth and the Telephone episode (which got a little long on us) we present this quick look a specific program used by FQHCs and other practices, the Medicare Chronic Care Management Program. It’s useful to consider because of its emphasis on establishing a regular check-in with patients, and has been utilized to continue and increase those check-ins during COVID-19. Here, Nicole Keaty, an RN at Little Rivers Health Center, explains how she is using the program.

Chronic care management as a general topic is much, much larger than this one program and is an important area for telehealth tools. It will undoubtedly be a future episode, but this snapshot of one program is useful for thinking about how we use telephone connections in particular towards better health in our communities.

Another quick mention is given to the OneCare Vermont outreach tool for connecting with higher risk patients during COVID-19. We’ll talk with OneCare more in the future about their programs, but wanted to add a quick mention in this episode to remind everyone that we aren’t only going with outreach programs that were in place before the emergency – there are also new outreach tools being built. Here's a blog post from OneCare on the latest updates to their application.

If you want to learn more about payment reform, another thing that gets a nod here, we've got a whole first season on that, check it out at Welcome to Payment Reform.

Thank you to Northern Counties Health Care for supporting this special series on telehealth and COVID-19.

This episode of Policy in Plainer English tackles Telehealth and the Telephone, with Dr. Audrey Von Lepel (NOTCH) and Dr. Adam Greenlee (Community Health Centers of Burlington). We thank Northern Counties Health Care for supporting this series. For all the details you could ever want on telehealth during COVID-19, visit this provider resource page from Bi-State Primary Care Association. 

Update (4/30): Since this episode was first recorded, Medicare has adjusted audio-only telephone options, the telephone is still not a fully recognized option for delivering health care services during COVID-19, but it is much closer to being there.  

There are a few reasons why using the telephone is a hot topic right now. The COVID-19 response opened up options that didn’t previously exist, importantly Vermont recognizes the telephone as a way to deliver telemedicine (the part of telehealth that replaces and office visit) and insurers are offering more options for what we call “triage calls”, or more formally brief telecommunications initiated by the patient. That last type of call, for Medicaid and Vermont Commercial payers, does not impose any cost share on patients.

Medicare doesn’t play by the same rules.

For one thing, those brief calls do have a cost share – something which many people see as unfair. Cold comfort is that, for the length of the emergency, providers won’t be forced to collect the co-pay from patients. they can pay it themselves instead.

The even bigger issue is that Medicare does not recognize the telephone as a device that can replace an audio-visual connection for telehealth services. This rule plays out different ways for different provider types. For federally qualified health centers, we have a code (G0071) that can be used to indicate a telephone service – and it pays $24. If we waive the co-pay, that’s more like $20. You don’t need to know a whole lot about health care economics to know that you cannot run a medical practice when the entirety of a doctor’s visit, from patient scheduling to chart review to prescription reconciliation to time on the phone to follow up and all the administration that goes along, reimburses you $20. 

As this episode points out, the problem isn’t just one of revenues during COVID-19, it’s the problem of what health care will look like after COVID-19 – who has access, who doesn’t, and whether doctors and patients will be able to work together to design the kind of health care that ensures nobody gets left out. 

As foreshadowed in the previous episode, we can't go much further into exploring telehealth during COVID-19, and its prospects for being available after COVID-19, without discussing reimbursement. So here we dip our toes in.

If you want to do more than toe-dip, the entire narration can be considered an audio introduction to this guide to telehealth expansion from Bi-State Primary Care Association, which you can read at your leisure. New rules get released pretty much daily, so if you follow this page you'll have plenty of updates to keep you entertained - it's regulatory guidance in serial novel format.

One thing that might help with this episode is to listen to our old episode on the difference between "telemedicine" and "telehealth". 

The good news? You can simplify this to think of telehealth being the broader universe of remote, digital health care, and telemedicine to be the narrower application where you are using a live, interactive patient-provider connection to replace a typical face-to-face office visit.

The bad news? Medicare uses "telehealth" to mean what everyone else calls "telemedicine" and they use "telemedicine" to mean everything that isn't "telehealth."

That fact alone should give you a taste of what it feels like to try to understand the world of telehealth reimbursement. . . enjoy the episode. Next time, we'll get back to some more provider stories. 

Around the beginning of March, life got very busy in the health care world. Producing episodes of Policy in Plainer English was not top of the to-do list.

At the same time, responding to the COVID-19 crisis is a pivotal moment in health care and an important time to share information about health care policies. With that in mind, we're back with a streamlined-for-easier-editing (yet still flawless in content) format for Policy in Plainer English PHE Edition. Here, we begin a series on Telehealth.

If you want to read ahead and know what's happening with Vermont telehealth during COVID-19, this link will take you to the Bi-State Primary Care Association telehealth updates page. From CMS' outbox to your browser, we try to keep this page as cutting-edge up-to-date as possible, check it out!

Thank you to our podcast sponsor Northern Counties Health Care for making this second season possible. 

Luca Fernandez, from the State Office of Rural Health and & Primary Care, which is within the Vermont Department of Health explains HPSAs - a particular term you'll hear come up the moment you dip a toe into the waters of health care workforce development.

You can browse HPSAs online here - remember that this podcast is talking primarily about geographic HPSAs, not auto-HPSAs or facility HPSAs, so set your search terms accordingly.

Vermont Department of Health (VDH) workforce data, including providers at retirement age by different geographical regions.

Shortages and distributions of health care workers, maps from VDH.

The Rural Health Services Task Force white paper on workforce shortages, from January 10th, 2020. 

Special thanks to Katherine Kulp, from Middlebury College, who helped with this episode.

In this mini-episode we pause for a moment to describe the difference between telemedicine and telehealth. Yes, there's a difference. Yes, it's confusing.

An interview with Dr. Anje Van Berckelaer of Battenkill Valley Health Center about Electronic Health Records (EHRs). Find show notes and links to all the episodes at plainerenglish.org 

Background music is by FesliyanStudios.com

An interview with Dan Bennett of Gifford Health Care about Community Health Needs Assessments.

CHNAs are publicly available, check out Gifford's for an example. This Green Mountain Care Board presentation from June 2019 summarizes common themes from CHNAs submitted with hospital budgets, and the GMCB also publishes an online library of the CHNAs they receive. 

Background music is by FesliyanStudios.com