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New Telehealth Regulations and Their Impact for Orthopedic Practices

By Molly Van Oordt

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In the fight against COVID-19, the rules around virtual visits are changing rapidly. Just in the past month since this pandemic began, telehealth usage has accelerated in healthcare practices across the country.

What was once a consumer-driven convenience is now a forced safety precaution to minimize the potential spread of infection. This shift toward virtual visits is helping providers stay operational and ultimately keep their doors open during this uncertain time. Orthopedic practices are also rapidly adapting the way they treat patients during the COVID-19 outbreak. With the recent announcement of new Medicare telehealth regulations in the wake of COVID-19, the prior model for provider-service reimbursement has shifted—making it a lot easier to submit and receive payment for telehealth appointments. 

New Medicare requirements – uncertain future

Prior to COVID-19, covered Medicare telehealth service requirements stated that the patient had to be seen during a live visit for an approved service, delivered by an approved provider for a patient in a rural geographical area when the patient is physically present at the healthcare facility. Due to all the restrictions around limited approved payment codes, many healthcare providers shied away from adoption of telehealth services due to concerns around waste, fraud, and abuse, as well as the economics around adding additional fee-for-service visits. In a value-based world, many would regard these visits as preventative care that reduce hospitalization and other high cost medical instances, but data that feeds into CMS and to Congress has yet to prove this.  Once a vaccine for COVID-19 has been found, it remains to be seen whether Medicare service requirements will return to these original requirements. 

How will these changes impact Orthopedic practices?

The options are endless for orthopedics practices to incorporate an integrated telehealth solution, which is a good thing with all non-essential physical doctor’s visits on pause from coronavirus. Ultimately, the use cases for telehealth are up to the practice and what works best for the providers there. Virtual post-op follow-up visits, wound checks, test review and after-hours care were services being thought about and done pre-COVID-19, but the outbreak has introduced a new world with new rules. Currently, the focus is all about taking care of the patients however possible, and that means finding a different way to see them. In the short term, providers are still able to take care of their patients while keeping their staff safe. In the long term, it’s going to improve patient experience and access and reduce costs. The changes recently announced for evaluation and management of telehealth eliminate the need to submit documentation for patient history and physical exam for a virtual visit, making it easier for practices to get paid. For example, we are already seeing some orthopedic practices implement x-ray-only visits, so the initial and follow-up appointments are done virtually.

When you are searching for a telehealth platform, it’s best to partner with an integrated solution to optimize the patient and provider experience, but also one that’s agnostic so providers can adopt telehealth capability irrespective of the electronic health record (EHR) platform they use. 

What hasn’t changed?

Before the COVID-19 pandemic, consumers were already pushing the industry out of its proverbial comfort zone, with the demand for greater autonomy, convenience, and control over their healthcare experience. Now, more than ever, patients will prefer to see their own doctor virtually and will increasingly choose medical providers who offer virtual visit capabilities over those who don’t. Similarly, providers will want to continue to see their own patients virtually, get paid for it, and will want video visits to integrate with their practice management workflow and the EHR. Our hope is that this newfound adoption of telehealth becomes one of the silver linings that will result from this pandemic. 


Molly Van Oordt

Director, Specialty Solutions

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