On August 3, 2020, President Donald Trump signed an Executive Order (EO) aimed at expanding access to telehealth services beyond the COVID-19 pandemic. In the EO, Trump specifically highlighted the plight of rural Americans when it comes to healthcare access – noting that “Americans living in rural communities face unique challenges when seeking healthcare services, such as limited transportation opportunities, shortages of healthcare workers, and an inability to fully benefit from technological and care-delivery innovations” and that those factors have contributed to “impaired health outcomes” for rural Americans, who are more likely to die from five leading causes than their urban counterparts are.
The EO notes that after telehealth flexibility was implemented by the Trump Administration for the COVID-19 pandemic, there was a weekly jump in virtual visits for CMS beneficiaries, from roughly 14,000 to almost 1.7 million the last week of April. Additionally, almost half of Medicare fee-for-service primary care visits were provided through telehealth in April, compared to .1% in February of this year. This increase in telehealth visits continued into May, even after in-person primary care visits resumed.
Based on that increase in visits, the EO asks for the Department of Health and Human Services (HHS) to review some of the temporary measures implemented during the COVID-19 pandemic and propose a regulation to extend the measures beyond the public health emergency. HHS should specifically focus on the additional telehealth services offered to Medicare beneficiaries and various flexibilities (services, reporting, staffing, and supervision) given to Medicare providers in rural areas.
The EO also addresses challenges around volume-based reimbursement for rural providers within the Medicare program by asking HHS to announce a new value-based payment model to provide “necessary, high-quality” telehealth care in rural areas by the beginning of September. The model is expected to extend providers flexibility from existing Medicare rules and establish predictable financial payments for providers.
HHS has also been asked to work with agencies across the Administration, including with the U.S. Department of Agriculture and the Federal Communications Commission (FCC), to improve the physical and communications healthcare infrastructure. Specifically, the collaboration should produce a strategy to improve health by utilizing existing resources to enhance broadband and other aspects of infrastructure to make healthcare more accessible to rural communities.
HHS is also tasked with drafting and producing a report within 30 days that outlines ongoing and planned programs tailored toward increasing rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals and develop rural-specific efforts to drive improved health outcomes. Specific emphasis will be placed on rural efforts to reduce maternal mortality and strengthen mental health services.
Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma applauded the EO, saying that “the Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”