Medicare to expand telehealth for elderly
WASHINGTON — Medicare said Tuesday that it will immediately expand coverage for telemedicine nationwide to help senior citizens with health problems stay home to avoid exposure to the coronavirus.
Meanwhile, nearly 7 million people in the San Francisco area were all but confined to their homes Tuesday, while Florida put a damper on spring break and St. Patrick’s Day by or
dering the closing of all bars, as state and local officials took an increasingly hard line against the coronavirus.
The new Medicare option will allow millions of older people to take care of ongoing medical problems as well as new concerns, while heeding public health advice to stay home during the outbreak.
For example, a patient with diabetes wouldn’t have to postpone a regular follow-up visit with the doctor to keep safe — he could do it via Skype. And people concerned that they may have the virus could “see” their doctor or nurse practitioner virtually to find out how to get tested in person.
“It helps us prevent the spread of the virus,” said Medicare administrator Seema Verma.
For senior citizens who don’t navigate technology, relatives or friends can assist. “If it’s your mom, you may need to go over to her house to help her do this,” Verma said. But don’t visit if you’re feeling sick, she warned.
Risk of serious illness from the coronavirus is greater for older people and those with underlying health problems such as lung conditions, diabetes or heart problems. Many Medicare beneficiaries are managing chronic health issues that put them at heightened risk. The telemedicine expansion is geared directly to that vulnerable group.
Current telehealth coverage under traditional Medicare is limited. It’s available in rural areas, and patients need to go to specially designated sites for their visits. Since last year Medicare has also been paying for brief “virtual check-ins.” Tuesday’s announcement goes beyond that, allowing clinicians and hospitals to bill Medicare for visits via telemedicine that previously had to take place in person, at a medical office or facility.
The policy change carries out a waiver of Medicare rules recently authorized by Congress, and set in motion under emergency declarations from the Trump administration. Expanded telemedicine coverage will remain in effect during the outbreak.
PRIVATE INSURERS
At a White House briefing Tuesday, Verma said the federal Centers for Medicare and Medicaid Services is also encouraging states to expand the use of telehealth in their Medicaid programs for low-income people. Separately, Medicare Advantage plans offered by private insurers have been allowed to offer telemedicine as a supplemental benefit, like dental coverage or a gym membership, for several years now. The private plans serve about one-third of Medicare’s more than 60 million beneficiaries.
For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.
Medicare is the government’s flagship health insurance program, covering people age 65 and over, as well as younger people who qualify because of disability. About 40 million people are in traditional Medicare, the government-administered part of the program that was the focus of Tuesday’s announcement.
Doctors’ groups and hospitals had been urging Medicare to make the move. Under Tuesday’s announcement:
■ Patients and clinicians will need a two-way visual and voice connection that allows real-time interaction.
Laptops, tablets and smartphones should work. Penalties for potential violations of federal health care privacy laws will be waived for goodfaith efforts to serve patients.
■ Hospitals and a range of clinicians, including doctors, nurse practitioners, clinical psychologists, nutrition professionals and licensed social workers will be able to offer telehealth. Nursing home residents will also be able to consult doctors via telehealth.
■ Standard Medicare copays and deductibles still apply to telemedicine visits. But there’s flexibility. Normally, health care providers cover such copays for telehealth visits. During the coronavirus emergency, health providers will be allowed to waive or reduce cost-sharing for telehealth visits.
■ Legislation authorizing the waiver required medical offices to have an established relationship with a patient to bill for telehealth services. But Medicare said it will refrain from enforcing that requirement via audits during the coronavirus public health emergency. Verma said that’s to allow for circumstances such as a medical practice being forced to close because of the outbreak.
“Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered … and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services,” Health and Human Services Secretary Alex Azar said in a statement.
If telemedicine shows its worth in the coronavirus emergency it could lead to permanent changes making it more widely available to senior citizens.
Telehealth has grown steadily in recent years. Most midsize or large employers now offer some way to connect patients and health care providers virtually.
But researchers say patients have been relatively slow to try telemedicine, especially if they are used to in-person visits.
ALL 50 STATES NOW
Medicare’s announcement Tuesday came as coronavirus infections across the country reached about 5,200, and the death toll climbed to at least 97, with more than half of the dead from Washington state. Worldwide, more than 7,500 have died from covid-19 with more than 190,000 infected with the virus.
West Virginia Gov. Jim Justice on Tuesday night said the state has reported its first positive case of the new coronavirus, meaning that all 50 states have now confirmed cases.
Officials in six San Francisco Bay Area counties issued a “shelter-in-place” order that went into effect Tuesday, requiring most residents to stay inside and venture out only for food, medicine or exercise for three weeks — the most sweeping lockdown in the U.S. against the outbreak.
“It’s really a scary situation for us because if we don’t work, we don’t eat,” lamented Miguel Aguirre, a janitor at San Francisco’s Boys and Girls Club.
Over the past day, new and more urgent warnings have come from the White House, which has called on Americans not to gather in groups of more than 10 and advised older people to stay home.
Still, the response across states varied.
While beaches on Florida’s Gulf Coast were still open, and at least one was full of spring breakers, Gov. Ron Desantis ordered all of the state’s bars and nightclubs closed for 30 days and asked Florida’s university system to send students home for online instruction for the rest of the spring semester.
Desantis has said he would leave beach restrictions up to local authorities.
LIMITED GATHERINGS
In Texas, Gov. Greg Abbott has left many decisions up to local governments. Unlike other governors of heavily populated states, Abbott has not made explicit calls for limiting mass gatherings.
“This is not a time to panic,” he said. “It’s not as if we have never been through this before. We’ve been through this many, many times.”
Meanwhile, millions of Americans were holed up at home, many thrown out of work until further notice as offices, stores and other businesses shut down. School was canceled for tens of millions of students, forcing parents to scramble for child care or find ways to entertain their children.
The rapid work stoppage had Americans fretting about their jobs and their savings, threatened to overwhelm unemployment benefit programs, and heightened fears that the country could plunge into a recession.
Health officials say that “social distancing” — encouraging people to avoid close contact with others — is a key to slow the spread of the virus and keep U.S. hospitals from being overwhelmed with a sudden deluge of patients.
In Detroit, bus riders were stranded Tuesday after most drivers didn’t report to work, apparently concerned about the spread of the virus and confused as to whether Michigan’s new restrictions on gatherings included vehicles loaded with commuters.
The city canceled bus service shortly after 8 a.m. because of the shortage of drivers. Surprised riders waiting at stops across the city pulled out phones to try to get lifts from friends or relatives.
Information for this article was contributed by Ed White,Angela Charlton, Geir Moulson, Kelli Kennedy, Terry Spencer, Mike Schneider, Sophia Tareen, Tammy Webber, John O’Connor, Christina A. Cassidy, Julie Watson and Olga R. Rodriguez of The Associated Press.