With the COVID-19 public health emergency coming to an end in mid-May, healthcare industry groups are focusing on what’s next for stakeholders at this new stage of the pandemic.
The Biden administration recently announced its plans to wind down the PHE, which was originally declared at the start of the pandemic in early 2020, and has been renewed every 90 days since. The PHE created new flexibilities for providers to expand access to care, such as new telehealth benefits, as well as expanded eligibility for Medicaid coverage, ensuring millions more Americans had health insurance coverage during the pandemic. Healthcare authorities warned providers, payers and stakeholders that the PHE would wind down at some point and they would be afforded at least 60 days’ notice.
The changes established in the PHE have been generally viewed as favorable as they have allowed more Americans to access care during a critical public health period. However, many industry groups have wondered what will happen once the PHE ends. Some of the temporary changes enacted in the PHE have already been extended to ensure providers aren’t faced with sudden disruption in care and billing.
“The impact will vary based on state, patient and payer mix. Fortunately, Congress addressed most of the critical Medicare telehealth waivers in recent legislation (Consolidated Appropriations Act, 2023) by extending these waivers through 2024, which provides some predictability for practices,” Claire Ernst, director of government affairs of the Medical Group Management Association (MGMA), told Health Exec. “It also gives the administration and Congress more time to gather data regarding telehealth utilization, quality outcomes and cost.”
Telehealth took off in popularity at the start of the COVID-19 pandemic, in part due to the temporary halt of elective procedures and lockdown measures. Many Americans also put routine care on hold to avoid exposure to the virus. Ensuring providers could bill for telehealth was a critical position in the PHE that enabled care access for millions of Americans, though it is unclear if that benefit will become permanent.
“Several waivers are set to expire with the PHE conclusion, such as the requirement to utilize HIPAA-compliant platforms while delivering care via telehealth (OCR has exercised enforcement discretion) and the ability to treat patients via telehealth across state lines if certain conditions were met,” Ernst said. “CMS extended payment parity between in-person visits and telehealth through 2023, but I would be surprised if they made this change permanent. We will have a better idea of the agency’s mindset in the [calendar year] 2024 proposed physician fee schedule (set to be released in July 2023).”
Other healthcare groups see the move as necessary as part of the progression of the pandemic, though the progress made should still continue even as the PHE expires. And some of the changes made during the pandemic that better serve patients should be extended.
“The decision to sunset the PHE is a testament to the progress we have made, but that progress should not end with the PHE,” Stacy Hughes, executive vice president of the American Hospital Association, told Health Exec. “We should preserve many of the best care innovations that served us well during the pandemic, like expanded use of telehealth and the development of hospital at home programs. We will work with the administration to build on the lessons learned from the COVID-19 pandemic, beginning with our strong urging that many of the COVID-19 PHE flexibilities be made permanent.”
In addition, the end of the PHE comes at a time when healthcare providers are still facing significant challenges tied to COVID-19. In addition, the United States is still reporting nearly 300,000 new cases per week, nearly 4,000 new hospitalizations weekly and more then 3,700 new deaths weekly from COVID-19, according to the latest data from the Centers for Disease Control and Prevention (CDC). Health systems and hospitals are dealing with financial pressures from high inflation and rising costs, workforce constraints and more.
“While the country may be entering a new phase of the fight against COVID-19, hospitals and their caregivers continue to navigate a host of weighty challenges including workforce shortages and financial pressures, cost increases for equipment and drugs, disrupted supply chains and sicker patients,” Hughes said. “These issues will require continued attention and investment from the federal government.”
Ultimately, healthcare groups are glad to see a longer notice for the PHE to wind down, particularly after Congress already took action to ensure a smoother transition for some of the new benefits enacted during the pandemic.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."