The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.<\/p>\n
The telehealth and in-home hospital care programs were both temporary \u2014 but increasingly popular \u2014 options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.<\/p>\n
The shutdown has prevented Congress from extending them.<\/p>\n
More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University\u2019s Center for Advancing Health Policy through Research.<\/p>\n
As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.<\/p>\n
The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.<\/p>\n
Don’t miss out on what’s happening!<\/strong><\/p>\n Stay in touch with breaking news, as it happens, conveniently in your email inbox. It’s FREE!<\/p>\n Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that \u201call telemedicine is uncovered by insurance as of Oct. 1\u201d \u2014 so she had to cancel the routine appointment.<\/p>\n \u201cIt was just a follow-up appointment to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,\u201d Wynn said. Her health insurance company later told her it still covered telehealth visits.<\/p>\n There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.<\/p>\n \u201cIt\u2019s a misunderstanding,\u201d Apple said. \u201cI\u2019m not really sure what\u2019s happening, but it\u2019s unfortunate and very scary. There\u2019s so much uncertainty out there now, and we see insurance payers start to pull back.\u201d<\/p>\n Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.<\/p>\n \u201cIn rural America, it\u2019s often telemedicine or no medicine at all,\u201d said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.<\/p>\n There\u2019s an exception for telehealth rural residents \u2014 but only if they travel to a brick-and-mortar health care facility to get the remote health care service.<\/p>\n \u201cThe patients have to go to a clinic to receive that telehealth visit from a provider in a different location,\u201d Apple said. \u201cIt kind of defeats the purpose.\u201d<\/p>\n According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.<\/p>\n There\u2019s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.<\/p>\n Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.<\/p>\n \u201cThis is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing \u2014 because at this point reports we\u2019ve seen seem to suggest it is company by company, provider by provider,\u201d said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.<\/p>\n The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.<\/p>\n The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin \u2014 all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo\u2019s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker\u2019s Hospital Review.<\/p>\n In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker\u2019s report.<\/p>\n Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.<\/p>\n Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.<\/p>\n \u201cManagement scheduled a random call this morning with a super vague title. Then drop the bomb on us,\u201d wrote one poster in Texas. \u201cSo no job. Perfect!\u201d<\/p>\n In a direct message, the poster, who didn\u2019t want their name used for fear of getting in trouble at their hospital, told Stateline, \u201cThis obviously wasn\u2019t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn\u2019t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.\u201d<\/p>\n Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.<\/p>\n \u201cWe are hopeful that Congress will renew this innovative model of care in the future,\u201d Hawthorne said.<\/p>\n Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program \u201cto avoid needing to return multiple patients to a very crowded facility,\u201d said Jennifer Junis, president of OSF OnCall, which handles home hospital care.<\/p>\n There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program\u2019s start in 2020, it has helped 980 patients with home care through OSF\u2019s Saint Francis Medical Center in Peoria.<\/p>\n \u201cIt is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,\u201d Junis said. \u201cOur digital hospital program has allowed us to free up beds for our sickest patients who need them most.\u201d<\/p>\n ____<\/p>\n This Stateline<\/a>.org<\/a> story was distributed by Tribune News Service.<\/p>\n","protected":false},"excerpt":{"rendered":"The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired…\n","protected":false},"author":3,"featured_media":307983,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[64,4582,210,1141,1142,67,132,68],"class_list":{"0":"post-307982","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-business","9":"tag-editors","10":"tag-health","11":"tag-health-care","12":"tag-healthcare","13":"tag-united-states","14":"tag-unitedstates","15":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115383754510738417","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/307982","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=307982"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/307982\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/307983"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=307982"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=307982"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=307982"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}