Steve Hirst relies on virtual visits with his urologist, whose office is an hour away from his Broomall home, to stay on top of his treatment plan and renew medications.
But earlier this month Hirst, 70, got a notice from his doctor’s office informing him that it could no longer schedule telemedicine visits for patients like him who have Medicare because of new federal policy changes.
Medicare began covering telemedicine services during the COVID-19 pandemic and has maintained the popular offering through temporary waivers approved by Congress since. But the most recent of those waivers expired at the end of September when Congress failed to reach a budget deal and the government shut down.
The change specifically affects traditional Medicare, which is administered by the government for people 65 and older and some with disabilities. People with Medicare Advantage plans, which are administered by private insurers, should check with their plan.
Medicare coverage for virtual visits for mental health was made permanent after the pandemic and are not affected by the shutdown.
Some of the Philadelphia area’s leading health systems, including Temple Health and Penn Medicine, have said they are continuing to provide telehealth services to people with Medicare and temporarily suspending billing for those services, with hope that coverage will be reinstated when a budget deal is eventually reached.
But smaller provider practices may not have the luxury of delaying payment for thousands of dollars in services for an indefinite period of time.
With the government shutdown in its third week, Republicans and Democrats seem no closer to reaching a deal. The next vote is scheduled for Monday evening, though no deal is expected.
Another health policy issue — tax credits for people who buy insurance through Affordable Care Act marketplaces, including Pennie in Pennsylvania — has been a major sticking point in the ongoing federal budget debate. Democrats want the enhanced subsidies extended permanently as part of the budget deal, and Republicans have refused, arguing that lawmakers could address the issue separately, before the subsidies expire at the end of the year.
Meanwhile, the waiver’s expiration has left Hirst and others who are covered by Medicare unsure how they will access needed health services.
Telehealth’s rise
Telehealth rose in popularity during the COVID-19 pandemic, when people were urged to avoid hospitals unless they were having an emergency and when most routine procedures were canceled.
The approach was especially helpful to older adults and people with disabilities, who needed to stay in contact with doctors for ongoing treatment and who were considered particularly vulnerable to severe illness from COVID-19.
After the pandemic ended, many private insurers, Medicaid, and Medicare permanently adopted telehealth coverage for certain services, such as mental health, because of its popularity during the pandemic.
Medicare has used temporary waivers to continue telehealth coverage for other types of doctors’ visits.
Beyond patient popularity, research has found that telehealth visits can be as effective as in-person visits for certain types of care, such as palliative care for cancer patients, while improving access to patients with transportation challenges.
Philadelphia health systems respond
Philadelphia’s largest health systems said they are optimistic that coverage will be reinstated — either by a new temporary waiver or a permanent change — when Congress reaches a new budget agreement and the shutdown ends.
Temple Health will continue to provide telehealth services to Medicare patients for the next three weeks, in anticipation of Congress reaching a deal.
Penn Medicine has not billed Medicare patients for telehealth visits since the shutdown began and has paused its process for filing claims until the government reopens, a spokesperson said.
“Congress has been vocal in its support of telehealth and its value, and we are hopeful that legislation will be passed to ensure permanent Medicare telehealth coverage and flexibilities once the government reopens,” Penn said in a statement.
Main Line Health has been reaching out to affected patients to help them change previously scheduled virtual visits into in-person appointments or reschedule virtual visits that can be put off.
Jefferson Health did not respond to a request for comment in time for publication.
Patients in limbo
Hirst drives into Philadelphia to see his urologist in person once a year. Every three months, he has a virtual visit to check in and renew prescriptions.
Driving to Philadelphia for every appointment would be inconvenient, but Hirst will probably do it “for now,” he said.
But he worries about older adults and people with disabilities who can’t safely drive to the doctor’s office, and for whom virtual care is a lifeline. They could end up putting themselves or others at risk being on the road when they shouldn’t be. Or they may end up skipping needed care because they don’t have a ride.
“It makes no sense,” Hirst said.
