COVID-era waivers expanding telehealth reimbursements set to end this year

Health care providers supercharged their telemedicine offerings as a result of the pandemic—however, how those providers will be reimbursed for virtual care moving forward is in question.  

Prior to the pandemic, most providers did not receive enough reimbursements from insurance companies to justify expanding their telehealth coverage.  

That changed when the Centers for Medicare & Medical Services, a federal agency that oversees Medicare and Medicaid programs across the country, introduced leniencies on HIPPA requirements on video software and broadened access to Medicare telehealth services.   

Third party payers followed suit by expanding their telehealth service coverage, offering advanced payments to independent health care providers and waiving fees for members using virtual care.  

Coverage that was previously based on the discretion of insurance companies, has become common across insurers, said Andy Carter, president and CEO of the Hospital Association of Pennsylvania (HAP). 

“The number one impediment to telehealth expansion was that there was no payment model that you could get return on your investment because a lot of insurers wouldn’t pay for telehealth consults or appointments,” said Carter. “COVID changed that dramatically, where immediately public payers and private payers were paying for it across the board.”  

In a 2022 report on national survey trends in telehealth use, researchers with the US Office of Health Policy noted that from March to April 2020, telehealth use skyrocketed across the country from 1% to 80% in “places where the pandemic prevalence was high.”  

Today, patient usage of telehealth is significantly down from the days of quarantine, with the report finding that percentage had dropped to around 20% among adult respondents to a survey given between Sept. 29 and Oct. 11, 2021.  

Providers see telehealth usage remaining much higher than pre-pandemic levels with the focus now turning to how providers and insurers can work together to standardize telehealth.  

Standardizing telehealth  

HAP has spent years trying to standardize telehealth protocols and practices, particularly when it comes to reimbursing providers for telehealth services.  

Their most recent effort on that front has been backing Senate Bill 705, legislation that would require insurers to pay providers no matter if that provider is in that insurers’ network.  

Carter said that in the past, the association supported bills that would provide parity between in-person and virtual care, meaning that payers would need to reimburse providers equally for either service, but the association has now agreed to leave pricing to individual payers and providers.  

“We argue that standardization is hugely important,” said Carter. “Insurance is already complicated enough and a patient’s access to care through telehealth should not be a lottery. Parity was a nonstarter for our friends in the insurance community. We agreed to new language as an alternative.”  

HAP is also currently in support of House Bill 2419, which would allow for more flexibility for the state to allow providers to offer mental health services through telehealth permanently.  

House Bill 2419 has been passed in the House and is currently awaiting consideration in the Senate.  

Pennsylvania’s COVID-era waivers that explicitly authorized telehealth services to expand during the pandemic will expire this October. 

The waivers were set to expire at the End of June and were extended by the General Assembly on June 30.  

The waivers expand access to telehealth services, increase vaccine access, allow hospitals to quickly adapt to emergencies by altering space as needed for influxes of patients, and ease regulatory barriers to clinician licensing. 

Pennsylvania does not have any statutes that will prohibit the practice of telemedicine after the waivers expire but payers will be able to stop reimbursing for telehealth.  

“Absent the current COVID driven waivers and flexibilities, we won’t sustain telehealth the way we did before COVID,” said Carter. “It’s not supposed to go away. People got used to it.”  

Providing care in the virtual space  

In the two years since providers have embraced telehealth, virtual care has had a massive impact on how the industry cares for patients.  

Providers are now looking at how things like wearable technology and remote patient monitoring can keep tabs on patient health between visits, said Christopher LaCoe, vice president of virtual health at Penn State Health.  

“We’ve moved to the point where we have all these opportunities to do checkups for diabetes. We might be able to do that stuff here and then send (the diabetic patient) to the eye doctor and not make them drive to our office,” said LaCoe, adding that educators are now taking telehealth services into consideration when they teach incoming providers. “Medical schools are putting this in their curriculum. They used to say you need to see diabetic (patients) every three months and now they say once a year.”  

LaCoe, credited the waivers, calling the changes that happened to telehealth the pandemic’s “silver lining.”  

Pittsburgh-based Highmark Health was early to the market on allowing telehealth for its providers, but prior to the pandemic, providers had little guidance on what that should look like, said Dr. Tim Law, vice president and executive medical director at Highmark.  

“Highmark said you can do telehealth, but we won’t tell you how to do it—it wasn’t front and center,” said Law, noting that changed quickly during the pandemic. “We put together a virtual care playbook. Five years ago, I don’t think anyone would have thought of doing this. It includes where to find supplies, how to access Bluetooth technology so you can do remote patient monitoring and we show them what states allow providers to work across state borders.”  

Highmark provides parity for its covered providers using telehealth with some of the states the payer operates in mandating it.  

However, even though some insurers are ahead of the curve with how they support and pay for telehealth with their covered providers, providers outside of a network may find themselves without telehealth reimbursements, said Carter.  

“Some insurers will say we provide telehealth to our covered lives. It’s only to the telehealth providers they’ve enrolled in their network,” said Carter. “That’s a model that leaves a lot of people without access to their preferred provider. Someone they know and trust.” 

Following historic peaks in telehealth usage last year, patients are expected to continue to use virtual care

If you were to ask any health system executive what the future of health care was in 2019, they would have said telemedicine. And in March of last year, with patients unable to access their physicians because of the quarantine, that shift to telemedicine happened in weeks, not years.

Telemedicine services through health care providers saw an immense peak in use resulting from the COVID-19 pandemic and, while many patients are returning to their physicians, area payers and providers have seen permanent changes in how patients expect care.

“When the pandemic hit, all health care providers were providing telehealth to some degree, but it was a small percentage,” said Jan Bergen, president and CEO of Penn Medicine Lancaster General Health during the Lancaster Chamber’s virtual State of the County event last month. “It gave us the ability to triage what patients needed to be treated virtually and who needed to be seen personally.”

Because of the pandemic, 2020’s telemedicine usage dwarfed 2019’s across hospital systems.

Last year, UPMC’s ambulatory telemedicine visits grew from about 250 a day in February 2020 to 15,000  by mid-April, said Dr. John Goldman, vice president of medical affairs at UPMC Pinnacle and infectious disease specialist.

“It’s since come down from that peak as more patients began to return to in-person clinical visits in our clean, safe hospitals, but today we still average about 6,500 telemedicine visits each day,” said Goldman.

Goldman added that improved telehealth services also means that patients have easier access to leading experts outside of the region, even if they are in an inpatient facility.

York-based WellSpan Health, which had already invested in telehealth products such as virtual urgent, primary and specialty care, and its MadelineRx online birth control solution, did more than 545,000 telehealth visits in 2020 as it expanded its services.

Ryan Coyle, a media relations and communications manager at WellSpan, said the patients ranged from newborns to the elderly, with 20% scheduled by patients over 60.

Penn State Health had also introduced telemedicine services prior to the pandemic but had focused on ALS care and urgent care through Penn State Health On Demand. In 2020, the Hershey-based health system saw its telehealth usage expand by 2,200%.

“We onboarded across our health system over 4,600 providers and staff,” said Chris LaCoe, vice president of virtual health at Penn State Health. “We enrolled around 60,000 patients and we really saw a massive uptick in our scheduled visits, our urgent care visits as well as some of the COVID screenings and testing that we had out there in the consumer space.”

Hospital systems in the region were already using video conferencing software between doctors and patients, and many health insurers already offered telehealth benefits prior to the pandemic. But reimbursements from third party payers, particularly Medicare and Medicaid, were much less than they would be in an in-person doctor’s visit if they were reimbursed at all.

HIPPA change

The changes started when the Centers for Medicare & Medical Services, a federal agency that oversees Medicare and Medicaid programs across the country, introduced leniencies on HIPPA requirements on video software and broadened access to Medicare telehealth services. Third party payers followed suit by expanding their telehealth service coverage, offering advanced payments to independent health care providers and waiving fees for members using virtual care.

Pittsburgh-based Highmark Health saw its members use telehealth services 3,400% more than they did in 2019 with over 3.4 million telehealth services being accessed.

Both Highmark and Harrisburg-based Capital BlueCross waived deductibles, coinsurance and copayments, also known as cost shares, for outpatient virtual visits last year and into 2021

“Early on, we realized the financial toll the pandemic was taking on those we serve, so we acted quickly to waive member cost shares,” said Jerry Reimenschneider, senior public relations specialist at Capital BlueCross. “We also recognized the economic strain the pandemic was placing on providers, and acted to ease that strain. During the public health emergency, we’re paying providers the same rate for telehealth visits that we would for in-person visits.”

At Capital, virtual visits through network providers grew from 22% of the insurer’s telehealth claims in 2019 to 81% last year. Capital saw its largest surge between March and May, but the increase was largely sustained throughout 2020, Reimenschneider said.

Here to stay

The region’s health care experts expect the changes in telehealth to stay to some degree. Dr. David Webster, executive medical director at Highmark, said that telehealth as an option to access care is here to stay.

“Behavioral health will likely be continued to be delivered via telehealth as there is rarely a need for a physical exam among other advantages of telehealth,” Webster said. “There will likely be some chronic disease management and urgent care among other services that will continue to be delivered through telehealth based on patient preference and if their clinicians continue to offer telehealth services.”

The problems of such a quick switch to telehealth were evident early on in the process according to LaCoe, who said that Penn State Health did not have the robust infrastructure that it does now and between that and the stress quarantining had on internet service, the first month of telehealth services was not devoid of issues.

While there will still be work needed to better integrate telehealth among providers and patients, LaCoe said that he doesn’t see telehealth services dialing back after the pandemic.

“If traditional health systems aren’t able to provide this service, there will be other groups out there that are willing to,” he said.

LVHN awarded FCC funding for telehealth services

The Federal Communications Commission (FCC) awarded more than $499,000 to Lehigh Valley Health Network in Allentown, which is set to use the funds for videoconferencing equipment, software, tablets and network upgrades.

The FCC also awarded more than $705,000 by to enhance telehealth services at Harrisburg-based UPMC, which will use the money for tablets, desktop computers, telemedicine carts and videoconferencing equipment to help improve communication between patients and their providers across the system’s facilities, the FCC announced.

The funds will also help the system launch an on-demand, virtual telehealth program to help triage, diagnose and treat COVID-19 patients and allow high-risk patients to stay at home, receive care and reduce exposure to health care workers and other patients, according to the FCC.

UPMC Pinnacle already offers video conferencing for COVID-19 patients and has grown its telehealth services exponentially since the beginning of the pandemic.

Within a week of increasing its focus on telemedicine, UPMC Pinnacle reported that it trained more than 650 ambulatory health providers and specialists to use its telehealth program.

The grant is part of a $200 million pool set aside for the FCC by the Coronavirus Aid, Relief and Economic Security (CARES) Act, approved by Congress in late March.

“The program provides immediate support to eligible health care providers responding to the COVID-19 pandemic by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services until the program’s funds have been expended or the COVID-19 pandemic has ended,” the FCC statement.

The hospitals are two of 514 organizations to receive awards through the department’s COVID-19 Telehealth program, which has already awarded $189.27 million in funding to health care providers across the country.


Drop in patients could shutter many independent clinics

Every flu season, Dr. Jeffrey Harris’s clinic in Newville, Cumberland County, is packed with patients. It was just as busy during outbreaks like the H1N1 scare in 2009. But the COVID-19 pandemic has been much different for the medical center, which is currently seeing less than half the patients it normally would.

Independent medical practices like Harris’s Graham Medical Clinic have overhauled how they offer in-person visits to protect their staff and patients from contacting COVID-19, but if patients don’t return soon to their providers, many small clinics – some say 30 to 50% — could face closures by the end of the summer.

“There is certainly anxiety among independent physicians and other specialties,” Harris said. “I never would have thought that a health crisis would bring our patient numbers this low.”

Dr. Nader Rahmanian, a Wyomissing, Berks County-based geriatric specialist, is seeing only 10% of his patients face-to-face.

Telehealth services have become much more profitable for health care providers in the past two months thanks to changes that the Centers for Medicare and Medicaid services made regarding how much Medicare pays for telehealth services during the pandemic. Still, telehealth’s expanded payout for Medicare patients, isn’t closing the gap because many of Rahmanian’s patients don’t have internet connections or phones to use the service.

For an independent clinic that relies on patient visits to get the most reimbursements possible from insurers, failing to get patients in the door will not only harm the patient but could be the end of the clinic.

“I need to bring them to the office or get them to the emergency room, but they are afraid to go anywhere,” Rahmanian said. “They don’t want to go to labs either because they are worried about exposure.”

At Jackson Siegelbaum Gastroenterology, which reopened its Camp Hill office this week, each of its provider teams are doing face-to-face visits with patients just one day a week, said Heather Nairn, COO at Jackson Siegelbaum.

The gastroenterology group also operates a surgery center in Camp hill and another office in Harrisburg, which is planned to reopen by the end of the month. When they open, there will be changes: checkpoints for staff to check the symptoms and temperatures of patients before they enter the building, and waiting rooms that have been redesigned to keep patients six feet apart.

Heather Nairn, COO at Jackson Siegelbaum, said that providers need to go above and beyond safety measures to demonstrate to staff that they are willing to do what it takes to keep them safe.

“If you are demonstrating to your staff that you want to protect them, they are going to take that and transmit it to your patients when they call them to schedule and when they see them in the office,” Nairn said. “That message goes through.”

Both Rahmanian and Harris are relying on federal assistance to keep their employees on staff and remain operational, but with experts predicting that the COVID-19 pandemic will last long into the year, small clinics without the backing of large health systems will need additional help. Loans such as the Patient Protection Program are keeping clinics open by providing money to pay staff, but in the coming months Rahmanian estimated that 30% to 50% of the state’s independent practices may have to close or furlough their businesses. Other practices may be able to survive by partnering with area health systems.

Third party payers have yet to offer the same reimbursements for telehealth services as Medicare, meaning that providers will need to stomach the lower reimbursements for care if they continue to offer telehealth.

Nairn said she would like to see further support from commercial payers as well as other vendors that work with health care providers to help these small businesses stay open and retain employees.

“This is the time that we need a call to action for everyone to focus on the philosophy of people over profits and let’s build some partnerships to get through this crisis,” she said.

Patient First adds telehealth, COVID-19 testing services

Regional urgent care provider Patient First is offering telehealth appointments for its patients in Pennsylvania, and drive-up COVID-19 testing at a number of its locations in the state.

In a press release the health care company said that telehealth services are available for anyone 18 or older who was previously a patient at one of the Patient First brick-and-mortar clinics in the past five years.

Patient First now offers telehealth services and COVID-19 testing. PHOTO/SUBMITTED –

Patients can call ahead to determine eligibility for a telehealth appointment. Eligible patients will be connected to a physician who will review medical history and conduct a virtual exam.

If a prescription is needed the physician can electronically transmit it to the patient’s pharmacy.

For patients who have insurance that covers telehealth visits, Patient First will bill the insurer. A routine visit will cost $75, and $35 for a follow up, for patients without telehealth coverage.

Covid-19 testing

Patient First has also begun offering drive-up COVID-19 testing at a number of its locations.

Sites with drive-up testing capabilities include the location on Schoenersville Road in Bethlehem; Papermill Road in Wyomissing; Jonestown Road in Harrisburg and East Germantown Pike in East Norriton in Montgomery County.

Testing is by appointment only.  Appointments are made by calling a designated testing center.

Patients will be asked about symptoms and risk factors to determine if they meet screening criteria based on guidance from the Centers for Disease Control and Prevention. Criteria include the presence of COVID-19 related symptoms such as shortness of breath, coughing and a fever.

Those who work in health care or need a test to determine eligibility to return to work or to obtain needed health care treatments, such as cancer treatment, are also eligible.

Samples are sent to a third-party reference lab for testing.  Results will generally be available in about two to four days and will be accessible on Patient First’s Patient Portal.

Most testing is covered by health care insurance. The cost is $90 for those who are self-paying.

Testing is scheduled from 9 a.m. to 1 p.m. and 2 p.m. to 6 p.m., seven days a week.

Coordinated Health opens virtual orthopedic injury center

Coordinated Health, a subsidiary of Lehigh Valley Health Network, opened a virtual orthopedic injury center that will allow patients to receive care for orthopedic injuries like sprains, fractures and back pain from anywhere.

The center will use virtual visit technology in place of face-to-face visits. The tactic reduces a patient’s potential exposure to COVID-19.

Patients who call an injury hotline number (610-861-8111) will be transferred to an orthopedic surgeon or physician’s assistant who will initiate a virtual visit through phone or video. Patients who need further care will be referred to an injury center or emergency room.

According to LVHN, virtual orthopedic injury center visits are covered by most insurances.


St. Luke’s adds telehealth system to remotely monitor COVID-19 patients

St. Luke’s University Health Network is using a new cloud-based telehealth platform to remotely monitor COVID-19 patients.  The platform, called Masimo SafetyNet, uses wearable single-use sensors to keep track of patients’ symptoms.


“This technology is game-changing in light of the crush of demand on our hospitals during this COVID-19 pandemic,” said Dr. Aldo Carmona, vice president of clinical innovation for St. Luke’s.

The platform tracks oxygen levels in the blood and respiration rates of patients who are hospitalized or quarantined at home, then makes the data available from a patient’s smartphone or smart device.

According to St. Luke’s, tracking a patient’s physiological data remotely can help clinicians make life-saving treatment decisions quickly.

St. Luke’s expects to monitor roughly 2,000 patients with the new device. These may also include staff and patients who are quarantined at home with the virus.

Rite Aid Corp. to offer virtual health care kiosks inside Rite Aid stores

Rite Aid has launched RediClinic Express, a virtual health care kiosk, available in  southeastern Pennsylvania and New Jersey sites.

Through a partnership with Health, a Goleta, California based telehealth company, Camp Hill-based Rite Aid will connect patients to clinicians via the RediClinic Express kiosks, according to a company statement.

InTouch Health’s virtual care software platform, Solo, allows patients to speak with RediClinic clinicians directly via a secure, two-way high-definition audio/video connection.

“The retail pharmacy is becoming an important destination within the healthcare ecosystem,” said Joseph M. DeVivo, CEO of InTouch Health.

Medical visits in a RediClinic Express, with the help of trained medical assistants, use the same diagnostic equipment used during face-to-face examinations, such as an otoscope, dermascope and stethoscope.

Patients are able to see exactly what the clinician is viewing, which aims to increase understanding and build trust between the patient and provider.

“Virtual care is another opportunity for Rite Aid to offer patients the convenience of faster service and value-based healthcare,” said Jocelyn Konrad, executive vice president of pharmacy and retail operations for Rite Aid.

Rite Aid launched its first RediClinic Express kiosks in Drexel Hill and West Chester, Pennsylvania and will launch three additional locations in Langhorne, Huntingdon Valley and Narberth, Pennsylvania.

These locations will initially offer care for illnesses including flu, strep, urinary complaints and preventive and wellness visits, such as travel health consultations for patients 18 months and older.

Patients will have the ability to schedule appointments online, use a self-service touchscreen for check-in, or speak with the kiosk’s clinical assistant upon arrival for an appointment.

During a RediClinic visit, the clinician may diagnose the patient and determine the appropriate course of treatment following clinical care guidelines.

If patients require a prescription or follow-up care, the clinician will then submit the prescription to the patient’s pharmacy of choice and, if needed, recommend that the patient visit an appropriate healthcare provider.

RediClinic, a subsidiary of the Rite Aid Corp., currently operates 25 clinics inside Rite Aid stores in the greater Philadelphia and New Jersey area.

Rite Aid is a national drugstore chain with 2,466 stores in 18 states and an annual revenue of $21.6 billion as of 2019.