San Diego medical providers continue telehealth appointments despite shutdown

With millions stuck in their homes during the COVID-19 pandemic, Congress authorized temporary telehealth benefits for Medicare beneficiaries in 2020, allowing medical providers to bill for online visits as if they were conducted in person, a boon that has been so popular that it has been reauthorized every year since.

But the current government shutdown has prevented such an extension this year, meaning that last year’s temporary reauthorization ended Oct. 1, generating nationwide headlines that seniors’ telehealth benefits will be on hiatus until a new resolution is passed.

But it is not that simple.

A wide array of organizations, including health care policy research firm KFF, the American College of Emergency Physicians and CalPERS, the state retirement system, indicate that Medicare Advantage plans are not automatically affected. Advantage plans, which use private companies to manage Medicare benefits, cover about half of the 69 million Americans enrolled in Medicare, including about 327,000 of the 600,000 living in San Diego County.

A survey of the region’s largest medical providers found a range of different approaches to preserving telehealth benefits, with the majority reporting that access to online visits has not immediately evaporated, as many speculated that it would. But exactly how the situation will change as the government shutdown continues is far from clear.

UC San Diego Health reported that it maintained all telehealth appointments thus far, but will eventually need to take action if the shutdown does not resolve soon. Scripps Health, by comparison, has already rescheduled hundreds of telehealth appointments, asking many with Medicare coverage to instead visit their doctors or other medical professionals in person. Kaiser Permanente generally serves Medicare patients through Advantage plans, which are not affected.

Scripps Health’s two most sought-after medical groups ended their participation in the Advantage program in 2023. But administrators have found that some on original Medicare, which requires supplemental “Medigap” plans and separate prescription drug plans to cover 100 percent of costs, can still maintain telehealth access during the shutdown.

Medicare patients enrolled in “accountable care organizations,” health insurance structures created by the Affordable Care Act, were granted telemedicine access in 2018, and it is also not affected by the telemedicine shutdown.

From  Wednesday, Oct. 1,  through Monday, Scripps reported that 435 Medicare enrollees had their telehealth appointments rescheduled as inpatient visits, while 642 were able to continue using telehealth because they had previously been assigned to receive their care from the Scripps Accountable Care Organization.

“Some Medicare patients no longer eligible for a telehealth visit elect to keep their telehealth appointment with the knowledge (that) Medicare is not currently covering the visit, and they may be financially responsible,” said Shane Thielman, a Scripps vice president and chief information and digital officer in an email.

Sharp Healthcare also has an Accountable Care Organization for its Rees-Stealy Medical Group, which is continuing its telemedicine access.

“We recognize the convenience and clinical value telehealth provides and will continue offering these services during this disruption,” a Sharp statement said. “We will follow all applicable guidelines regarding billing and reimbursement as they evolve, with our priority focused on maintaining continuity of care for our patients.”

Sharp said its statement also applies to Sharp Community Medical Group.

It was not clear on Tuesday how many Sharp Medicare beneficiaries not on Advantage plans would be affected by the telemedicine shutdown.

Dr. Christopher Kane, a urologist and chief executive officer for UC San Diego Health Physician Group, said late last week that the impact of not being able to bill Medicare for telehealth appointments, which make up between 18% and 20% of the organization’s 7,000 to 7,400 daily patient visits, could cost the system significant amounts of revenue per week. For now, he said, the organization will continue providing telemedicine visits and billing Medicare, hoping that claims will be processed after a short shutdown.

“We may have to adjust this decision if the shutdown goes on a long time, because each week that we don’t get reimbursement for Medicare is an expensive week for us,” Kane said.