Providing Outpatient Telehealth in the United States: Before and During COVID-19

Brotman, Joshua J.; Kotloff, Robert M.

Before COVID-19, telehealth evaluation and management services were not widely utilized in the United States and often restricted to rural areas or locations with poor access to care. Most Medicare beneficiaries could not receive telehealth services in their homes. In response to the COVID-19 pandemic, Medicare, Medicaid, and commercial insurers relaxed restrictions on both coverage and reimbursement of telehealth services. These changes, together with the need for social distancing, transformed the delivery of outpatient evaluation and management services through an increase in telehealth utilization. In some cases, the transition from in-person outpatient care to telehealth occurred overnight. Billing and claim submission for telehealth services is complicated, has changed over the course of the pandemic and varies with each insurance carrier, making telehealth adoption burdensome. Despite these challenges, telehealth is beneficial for healthcare providers and patients. Without additional legislation at the federal and state level, it is likely that telehealth use will continue to decline after the COVID-19 public health emergency.