Telehealth Takes the Field: A Permanent Solution to Expand Patient Care and Conduct Comprehensive Patient Assessments
By Arturo Diaz, Chief Operations Officer, Risk Adjustment Operations
As CMS expands telehealth for Medicare beneficiaries, our PopHealthCare leadership team is monitoring the impact of these policies on risk adjustment payments. Consistent with many of the findings in Seema Verma’s recent article in Health Affairs, our initial data indicates that telehealth is a viable short- and long-term solution to providing quality care to members and mitigating risk adjustment underpayments for health plans. Increased utilization, high member satisfaction, and the opportunity to mitigate against lower collection of HCCs suggest that telehealth as a lifeline for patients, providers, and payers is here to stay.
Increased telehealth utilization. CMS reports a significant surge of telehealth claims during the 3-month period between mid-March and mid-June 2020, with over 9 million Medicare FFS beneficiaries receiving a telehealth claim (representing 21% of the total Medicare FFS enrollment). During the same period, PopHealthCare client’s volume of risk adjustment telehealth claims also increased, from 0% to 19% of all risk adjustment claims in April 2020. For many of these members, these telehealth visits are the only encounter they have had with a provider in 2020. Given the surge of telehealth claims observed in the Medicare FFS program and selected Medicare Advantage plans, it appears that we have reached a tipping point for telehealth. COVID-19 and the Stay At Home Orders (SAHO) have been the catalyst to elevate telehealth into a sustainable role for care delivery and comprehensive patient assessment.
Telehealth utilization by population. Another important validation I noted between Medicare FFS and PopHealthCare findings is the telehealth participation dichotomy between Dually eligible Medicaid Medicare beneficiaries and non-duals. CMS reported higher rates of telemedicine use among dually eligible compared to Medicare-only, 34% and 26%, respectively. Analogously, PopHealthCare found 49% of Medicaid beneficiaries willing and technology enabled to schedule a telehealth In Home Assessment (IHA) compared to 35% of Medicare beneficiaries. Conversely, 60% of scheduled Medicaid IHA visits were later cancelled or not completed, compared to 42% of cancelled or not completed Medicare scheduled telehealth IHA visits. Telehealth can be a game changer for this dual population in providing consistent primary care.
Our data suggests that members are pleased with their telehealth experience. Among all PopHealthCare patients completing a telehealth IHA, 98% of survey respondents indicated satisfaction with the telehealth IHA and would consider a telehealth encounter in the future.
Telehealth vs Telephonic care. One growing concern is the mix of audio-only telephonic encounters and synchronous audio and video encounters intermingled and perhaps indistinguishable found in telehealth claims. CMS reports nearly one-third of the Medicare FFS beneficiaries with a telehealth claim received an audio-only telephonic service. PopHealthCare is also seeing telehealth claims include audio-only telephonic encounters. Consequently, PopHealthCare is advising our clients to examine their telehealth claims submitted for risk adjustment calculation in order to identify and exclude the audio-only encounters in order to mitigate a RADV audit risk, whereas CMS does not consider audio-only encounters as face-to-face.
Based on our findings of several thousand completed telehealth visits to date, we believe in the enduring power of telehealth to deliver quality care and risk adjustment data. To that end, PopHealthCare advises clients to encourage CMS to make telehealth a permanent modality to report diagnosis codes for risk adjustment consideration. Giving permanency to telehealth data collection will provide the assurance for health plans, provider organizations and their partners to invest in technology to address the known limitations of telehealth, including unreliable internet connectivity, inconsistent peripheral devices and communication technology platform failure.