Overview: In catastrophic injury cases the cost of future care is always a component of damages. While some treatments require on-site procedures, the use of telehealth and bio-metrics have recently taken substantial strides in managing and monitoring patient issues. The following provides an overview of recent changes in telehealth regulations, and how these changes will impact life care plans. In March 2020, President Trump authorized the Center for Medicare & Medicaid Services (“CMS”) to issue waivers to Medicare program requirements to support healthcare providers and patients during the pandemic. The expansion of Medicare telehealth allows all beneficiaries to receive telehealth in any location, including their homes, was the first action taken by the CMS. Soon afterwards, Senator Ted Cruz introduced in Congress a bill called the “Equal Access to Care Act,” which will open doors to interstate telemedicine. The CMS reported that in 2019, prior to the COVID-19 pandemic, the average number of telehealth visits conducted by medical providers was over 13,000. Due to the regulatory changes in relation to telemedicine, in the last week of April 2020, the number jumped to over 1.7 million beneficiaries who received telemedicine services.
How is Medicare Affected?
Prior to 2020, Medicare compensation for telehealth services was very limited, namely “when the person receiving the service is in a designated rural area and when they leave their home to go to the clinic, hospital or other medical facilities for telehealth medicine.” Under the Trump Administration telehealth services are a welcome solution. This, coupled with CMS’s Fostering Innovation Strategic Initiative results in the last three years improving access to virtual care nationally. Starting in 2020, Medicare has paid clinicians for e-visits, which are non-face-to-face, patient-initiated communications through an online patient portal across the country, not just in rural areas.
Additionally, the CMS implemented changes enacted by Congress so that Medicare Advantage plans can offer telehealth benefits to 13.7 million Medicare Advantage enrollees. In attempts to improve access to virtual care, the CMS added 135 allowable services and removed barriers to double the number of services that beneficiaries could receive via telehealth. From mid-March to mid-June 2020, over 9 million beneficiaries have received a telehealth service according to internal CMS analysis of Medicare fee-for-service claims data. This claims data indicates that beneficiaries are seeking medical care through telemedicine services while only 22 percent lived in rural areas and 30 percent of beneficiaries came from urban areas.
How Are Lawyers Affected?
For attorneys, the largest expense in any life care plan is the support care provided primarily by a Licensed Practical Nurse (LPN) for an average of 18 hours for a catastrophically injured patient at a nationwide cost of $49 per hour. If telehealth becomes the normal order of LPN support and service, nurses can make use of technology to conduct telehealth sessions in their homes, at doctor’s offices, in prisons, in clinics and hospitals. Wherever nursing is done in a telehealth setting, nurses can monitor a patient’s overall condition, namely oxygen levels, heart rate, respiration, blood glucose, and more medical readings remotely. For emergencies, nurses from around the United States can participate in telephone triage set-ups. Routine pre-surgical and post-surgical care can be administered with telehealth nurse help. Telehealth nurses can also help continue to develop the best practices for specific circumstances as they arise.
According to a new study based on data collected from 650 patients who used the JeffConnect telemedicine platform at Philadelphia-based Jefferson Health. The cost at JeffConnect was a flat fee of $49 paid upfront. The bulk of cost savings from telemedicine was generated in diverting patients from emergency departments. Each avoided emergency department visit generated a cost savings ranging from $309 to more than $1,500 per visit. Cost savings from other alternate care types were below $114 average savings per visit with a group of 650 patients. The researchers stated “the net savings to a patient or payer per telemedicine visit of $19 to $121 represents a meaningful cost savings when compared to the $49 cost of an on-demand visit. The primary source of the generated savings is from avoidance of the emergency department, as this is by far the most expensive of the alternative care options provided.” The onus now moves to litigation counsel to determine where and when telehealth should be incorporated into the lifecare plans proposed by the experts, and managed after trail settlement or judgment.
Predictions Not Required
Regardless of the future administration, studies consistently demonstrate the medical efficiencies created to both providers and beneficiaries via telemedicine services. It is possible that interstate telemedicine will soon be the norm, and Medicare will streamline the access of medical breakthroughs for seniors. Well-funded digital companies like Google and Amazon have come to recognize that future the future of healthcare will come in part from a wider acceptance of telemedicine services. If the care of litigants in traumatic injury cases can be effectively managed through telehealth, reducing the costs and time burdens of such care, we can expect a similar trajectory in drastically reducing the overall costs of lifecare plans. Attorneys can also expect the more than 275 companies in the United States that have invested heavily in the future of telehealth, to continue releasing cutting edge devices and software that improve upon current platforms, reducing the costs even further.
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