Tales From the Frontlines: ACP Advocates for Postpandemic Coverage for Audio-Only Visits

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Internal medicine physicians share their experiences with audio-only visits, explaining why access to these visits is vital for their patients

Oct. 7, 2022 (ACP) — The American College of Physicians is urging the Centers for Medicare & Medicaid Services (CMS) to retain coverage of audio-only services following expiration of the public health emergency (PHE).

During the early months of the COVID-19 pandemic when widespread shutdowns prevented in-person visits, the use of video visits soared. However, many patients did not have access to the high-speed internet required for such visits, so phone calls were the only way they could check in with their physicians about acute concerns and chronic conditions. The pandemic has shifted and in-person care has resumed, but audio-only visits continue to serve as a lifeline for many rural, elderly, and underserved patients, as well as people with a lower socioeconomic status.

In the proposed 2023 Medicare Physician Fee Schedule, CMS has proposed removing Medicare coverage for audio-only telehealth services after the end of the PHE, which is currently set to expire on Oct. 13, unless it is renewed.

ACP members are speaking out about the important role audio-only visits can play in patient care.

La Mesa, California-based internal medicine physician Dr. Shreya Chandra serves the rural and mountain regions of Alpine and Ramona and a large geriatric population. Audio-only visits have allowed her to regularly follow up with patients who have diabetes and hypertension.

“The audio-only services have been invaluable in working with patients in Ramona and Alpine as due to Wi-Fi networks, video services may not always be reliable,” said Chandra, who is a member of the ACP Coding and Payment Policy sub-committee.

Thanks to these visits, at least one patient did not have an hour commute to the clinic and was still able to achieve improved diabetic control through audio visits with Chandra and diabetic nurse practitioners. Another patient calls his diabetic audio-only visits with her his “Dr. Chandra fix,” she said.

Audio-only visits can also save lives, Chandra added.

She relied on audio-only visits when an elderly patient who lived alone in a senior trailer community stopped coming in for her appointments. “Through an audio-only visit, I was able to ascertain that she had had a decline in function and increased confusion about her medications,” Chandra said.

The patient had also been unable to cook meals and had been eating snacks instead of nutritious foods. “I was able to work with a social worker and a home health nurse to help her family transition her into an assisted living facility where her medications could be administered and she was in a safe environment with regular meals,” Chandra recalled. “Once she had an adjustment of her medications, she was able to regain her strength, and her caregivers are able to bring her into the office again for visits.”

Internal medicine physician Dr. Kristin M. Mitchell has been practicing in Soldotna, Alaska, for 20 years. Many of my patients live in remote areas where they do not have water or sewer or reliable internet service, said Mitchell, who also serves on the ACP Medical Practice and Quality Committee. Many other patients, particularly elders, struggle to master the telehealth technology at the time of their visit.

Just this past month, Mitchell had a patient scheduled for a telehealth follow-up after starting a new hypertensive regimen.

It did not go according to plan.

“She planned to have a grandchild help her with telehealth, but the family member was unavailable at the time of the visit, and my patient could not successfully install the Zoom app on her new computer and had forgotten her password to do FaceTime,” Mitchell said.

Fortunately, audio-only services are still an option. “I was able to review her home blood pressure results and evaluate the efficacy of her regimen and make appropriate adjustments during her scheduled appointment,” Mitchell explained. “If we did not have the audio-only option, my patient would have had to be rescheduled for an in-person visit, which would mean waiting weeks for an open appointment and driving more than an hour from her home.”

Many patients are also concerned about the cost of gas involved in traveling to the office for an appointment. “For my colleagues who care for patients within the Tribal Health System, whose patients live in remote areas of Western Alaska, audio-only services are even more helpful in ensuring that patients get the follow-up care they need because scheduling an in-person visit involves air travel,” Mitchell noted.

In a Sept. 6 letter, ACP urged CMS to collaborate with the American Medical Association Current Procedural Terminology and Relative Value Scale Update Committee workgroup on Telemedicine Office Visits to assess available data and determine accurate coding and valuation for evaluation and management office visits performed via audio-visual and audio-only modalities. ACP is also encouraging CMS to let physicians be the key decision-makers in determining which services could and should be performed via audio-only versus audio-visual. Absent access to audio-only services, ACP is concerned that many patients will not receive necessary care.

ACP acknowledges that audio-only may not require the same resources as audio-visual or face-to-face services, but if there is too large of a gap between reimbursement of audio-only and of audio-visual or face-to-face care, audio-only will not be utilized and the care of the Medicare population will suffer.

To further inform the ACP's ongoing advocacy for continued coverage of audio-only services, members are encouraged to share their experiences directly at policy-regs@acponline.org ACP is also launching a tool via the “Telehealth” webpage where members are encouraged to share perspectives and other information related to audio-only services.

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