Many Medicare patients can’t get telehealth during the shutdown : Shots

A few weeks ago, when Vicki Stern, 68, tried to schedule a virtual visit with her doctor, she was told that Medicare had — at least temporarily — stopped paying for telehealth appointments when the government shut down. So Stern was given a choice: make an appointment in person or pay for telemedicine out of pocket.

“So I said, 'Okay, when can I get an in-person appointment?' And it wouldn’t be until December.”

So Stern, who lives in Bethesda, Maryland, paid, hoping she'd be reimbursed when the government reopened. But Stern, who serves on the patient advisory board of Johns Hopkins Medicine, says the loss of telemedicine services makes life difficult for almost everyone, from the working person to Stern's 90-year-old mother, who hates traveling to and from the doctor.

“When I have a cold, do you really want me to go to the doctor’s office and consult with everyone else?” Stearn says. “There are so many different reasons why telehealth is a good idea.”

“An ongoing access disaster”

The use of telehealth in Medicare began in earnest during the pandemic and quickly became popular. Nearly 7 million people use Medicare use telemedicine services to see their doctors every year, but the federal government shutdown has brought payments covering these services to a screeching halt. In particular, temporary pandemic benefits, which had been repeatedly extended to ensure payments could be made, could no longer be reauthorized. Without this administrative approval, Medicare patients—and their doctors—are left in a very complex and confusing limbo.

“It’s an ongoing access disaster,” says Kyle ZebleySenior Vice President of Public Policy, American Telemedicine Association.

Even large hospital systems don't have much of a financial cushion to continue offering services without government reimbursement, he said. Additionally, there is no clear indication that providers will be reimbursed for telehealth services during the closure.

Hundreds of hospitals across the country have also suspended their investments in so-called “hospital-at-home” programs that offer more sophisticated remote monitoring and care that allow patients with more serious illnesses to stay at home. Zebley says those patients were either discharged or hospitalized if they needed ongoing care.

Zebley says this temporary shutdown of telehealth services is especially disappointing because is He is expected to return eventually and then hopefully become permanent. According to him, it is convenient, effective and loved by the entire political spectrum. “There is broad bipartisan support from the far-left member of the Democratic caucus and the far-right member of the Republican caucus—there is nothing less than universal support for maintaining these services. And yet here we are.”

Various ways to deal with interruptions

In the meantime, doctors' offices and hospitals must decide: Do they continue to offer services, do their prices fluctuate and do they hope to recoup payments from Medicare later? Or do they discontinue services and require patients to come in, potentially delaying appointments and forcing patients in rural areas to travel long distances?

Helen Hughes, a pediatrician and director of telemedicine at Johns Hopkins, says every health care provider she talks to seems to be taking a slightly different approach.

During the first two weeks of the closure, the Hopkins hospital and physician network continued to offer telemedicine appointments that had already been scheduled. However, they held off on billing Medicare in hopes that they would be reimbursed once the shutdown ended. “Our physicians enter the fee into our electronic health record, but we don’t send it to Medicare,” Hughes says.

But as the shutdown dragged on and unpaid costs piled up, Hughes and the hospital system changed course. On Oct. 16, they informed Medicare patients to schedule any new appointments in person.

Hughes says that, unfortunately, many of those being called back into doctors' offices are cancer patients or people undergoing neurological treatment – conditions in which driving can be a real challenge and a physical strain.

Pausing telemedicine isn't as simple as turning it on or off, Hughes said. In the years since the pandemic, Johns Hopkins University has created a centralized center with about 16 doctors who work remotely and therefore can see patients for longer hours, more days per week and more patients, even in rural areas.

This team continues to operate as it also accepts patients with private health insurance.

But Hughes worries that stopping telehealth in Medicare will delay progress, saying that “in this confusing environment” where patients are trying to “get access to this type of care and can't… we may lose confidence that this is a sustainable type of care.”