Neurology Groups Come Together to Support Continued Telemedicine Service, Payment Parity

Jill Giordano Farmer, DO, MPH

As many states across the US experience a resurgence in COVID-19 infections, many of the health care and insurance policies for telemedicine reimbursement that were enacted under the Department of Health CARES Act waiver¹ have begun to expire.

As of June 1, 2020, several commercial payers have reduced or stopped service and payment parity policies for telehealth despite an unprecedented level of interest and participation in telemedicine care among health care providers and patients.

The need to have continued access to telemedicine is particularly relevant in the neurology sphere, where vulnerable patient populations who require routine follow-up can be spared additional exposure in a health care practice or hospital setting by connecting with their provider via video teleconference or phone.

As such, a number of neurology organizations have come together under the leadership of the Women Neurologist Group and The Alliance for Advancement of Neuroscience to petition legislative representatives to support the continued use of telemedicine with service and payment parity across all 50 states and the District of Columbia.

Specifically, the organizations, which include 18 neurological societies, 3 academic institutions, 2 state osteopathic medicine societies, and 20 patient advocacy groups are calling on state government officials and private insurance representatives to uphold the following policies established by the CARES Act waiver:

• Payment parity for evaluation and management (E/M) services for new and established patients delivered via real-time interactive audio-video technology with in-person E/M services.
• Elimination of the originating site requirement for telehealth services.
• Removal of frequency limitations for subsequent inpatient and nursing facility visits, to instead determine frequency based on medical necessity and with clear definitions of what is appropriate and reasonable.
• Modification of direct supervision requirements so that direct supervision can be performed via real-time interactive audio-video technology.
• Addition of telehealth services that were added on a category 2 basis for the duration of the public health emergency.
• Coverage of remote physiologic monitoring codes.
• Coverage of telephone services E/M codes 99441-99443.

View the full petition here.

While larger organizations like the American Academy of Neurology are appealing to federal-level entities such as the Centers for Medicare and Medicaid, this petition encourages health care providers and their supporters to expand their advocacy to the state level to ensure that a uniform standard of care is adopted.

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Notably, prior to the public health emergency and the introduction of the CARES Act, only 29 states and the District of Columbia had service or payer parity laws in place, though many of these laws have conditions that are policy-dependent or only address service parity, but not payment parity. A number of states, including Alabama, Idaho, North Caroline, Ohio, Pennsylvania, Utah, and Wisconsin currently have no commercial parity laws in place for telemedicine services.

If nothing else, the coronavirus pandemic 2019 has demonstrated an unprecedented ability for health care providers and patients to quickly adapt to and optimize alternative care avenues. With COVID-19 surging across the US since February 2020, more than 90% of physicians have moved to treating some or all of their patients via telehealth, according to a survey of 1300 providers.² Of those, approximately 60% said they plan to use telemedicine services more often than they were prior to the pandemic.² This is echoed in the patient population, where a recent poll found that nearly 60% of consumers surveyed are more likely to use telemedicine services now than before, and 36% said they would switch providers in order to have access to virtual care.²

The impact of more broad access to telehealth services is perhaps greatest on those facing health care disparities, including those who live in rural areas where access to specialty care is limited or not available at all. The benefits are similar for seniors who may be homebound or those who have reduced access to public transportation, especially in light of pandemic-related travel restrictions.

Similarly, there are clear benefits for providers, who too are faced with navigating work-life balance amid the pandemic that has all but halted school and childcare across the country. Faced with increasing pressures at home and at work, the ability to conduct telehealth services may save some health care practices from shutting down completely.

The efforts of the Women Neurologist Group and other neurological organizations are being echoed across medicine, with a similar open letter signed by 340 health care organizations now circulating that urges leaders in the US Senate and House to make permanent the policies adopted under the CARES Act waiver.

What You Can Do:

• Contact your state medical societies to share resources and bolster efforts
• Send resources to local and national representatives via email and postal service
• Send resources to the following US Senators who are sponsoring a telemedicine bill: Commerce Chair Roger Wicker, R-Mississippi; Mark Warner, D-Virginia; Kyrsten Sinema, D-Arizona; Lisa Murkowski, R-Alaska; Lindsey Graham, R-South Carolina; and Amy Klobuchar, D-Minnesota
• Send resources to members of the National Governor's Association
• Send resources to commercial payers you interact with

For more information and to lend your support to the efforts to solidify telemedicine service and payer parity, please contact Jill Giordano Farmer, DO, MPH: jfarmer@gnineuro.org

REFERENCES

1. CARES Act: AMA COVID-19 pandemic telehealth fact sheet. American Medical Association website. Updated April 27, 2020. Accessed July 9, 2020. https://www.ama-assn.org/delivering-care/public-health/cares-act-ama-covid-19-pandemic-telehealth-fact-sheet

2. Alliance for Connected Care. COVID-19 Telehealth Polls — Patient and Provider Acceptance and Satisfaction. Accessed July 9, 2020. http://connectwithcare.org/studies-reports/