The COVID-19 pandemic is the biggest crisis to hit US health care in a century, jeopardizing the future of many medical practices, especially those in primary care. But like every crisis, this pandemic also brought opportunities for change. For medical practices, it could mean becoming nimbler in their operations, more accessible and affordable, and less dependent on fee-for-service payments. As Public Health Emergency (PHE) has ended, the question arises, what might primary care after COVID-19 look like? According to us, it will depend on two interrelated factors: whether the increased use of telehealth resulting from the pandemic continues after the end of PHE, and the availability of new payment models to support telehealth and other novel forms of care delivery.
Telehealth use, which had been extremely limited before the pandemic, surged after PHE and in-person patient visits declined drastically. According to the most recent report of the Medicare Payment Advisory Commission, there were 8.4 million telehealth visits paid under the Medicare Physician Fee Schedule in April 2020, compared with 102,000 in February. Providers were able to meet the surge in demand for virtual visits largely because Medicare more than doubled the number of telehealth-delivered services it would pay for, and increased payments for them, for the duration of the PHE. It also allowed clinicians to bill for some telephone-only visits (as opposed to visits that include a video component) and removed most site restrictions for remote visits.
One of the telehealth’s biggest potential impacts is to make care more widely accessible since it eliminates the need for travel to a provider’s office. With telehealth, providers can take care of patients who otherwise couldn’t come in whether because of transportation issues or because they couldn’t take time off from their jobs. Many providers mentioned that before the COVID-19 outbreak they rarely used telehealth, but now half of their clinic time is virtual. It has provided opportunities for patients to overcome barriers like lack of transportation, and it gives providers more options for virtual follow-ups in case of any concerns about changes in a patient’s health status.
The pandemic has shown the importance of compensation models that offer primary care practices more financial predictability and the freedom to innovate and seize new opportunities. The appropriate example would be the Comprehensive Primary Care Plus model, which CMS has been developing since 2017. It combines traditional fee-for-service payments with upfront per-beneficiary per-month fees and performance-based incentive payments. The pandemic has demonstrated the importance of value-based payments. For primary care advocates and many health policy experts, the uncertainty over telehealth’s post-pandemic role is characteristic of the pandemic’s larger takeaway. There is a need for new payment models that give providers more financial stability and greater flexibility in medical decision-making.
The pandemic’s full potential to transform primary care won’t be realized unless the changes the government put into effect at the start of the pandemic, allowing Medicare to reimburse for remote visits at parity with in-person visits, and reducing or eliminating visit site restrictions. Most providers’ organizations and other groups are trying to make the PHE telehealth rules permanent. CMS has launched a study exploring the possibility of doing that for at least some services. The whole point of expanding telehealth under the PHE was so that people wouldn’t have to leave home in order to receive routine medical care. But these changes are discontinued after the PHE, given the reason for a vast increase in Medicare spending and greater opportunity for fraud. Most private payers are also saying spending on telehealth is out of control.
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