The Evolution of Alternate Care Settings Under CMS COVID-19 Guidelines

As the COVID-19 pandemic threatened to overwhelm hospitals and health systems throughout the country, the federal Centers for Medicare & Medicaid Services (CMS) issued a series of regulatory changes to allow providers more flexibility in care settings as they deal with the crisis.

By issuing new rules and temporarily waiving some federal requirements, CMS has made it easier for local hospitals and health systems to accommodate any potential surge of coronavirus patients using alternative care settings, ranging from empty convention centers to virtual telehealth platforms.  

CMS Introduces “Hospitals Without Walls”

The initial CMS regulatory changes created “Hospitals Without Walls” for the duration of the pandemic. Under the relaxed regulations, hospitals could:

• Create new treatment sites in college dormitories, gymnasiums and arenas, convention centers, hotels, ambulatory surgery centers, inpatient rehabilitation centers, and other facilities. Hospitals can transfer non-COVID-19 patients to those facilities and devote their acute care beds to patients who have coronavirus.
• Use telehealth for additional medical services that were not previously permitted. This enables providers to use telehealth for services that had not been previously covered by Medicare. 

After the regulatory rollbacks were announced, the Federal Emergency Management Agency (FEMA), wasted little time setting up temporary hospitals in New York City, CMS administrator Seema Verma told National Public Radio (NPR) in a recent interview. Among the temporary facilities established in New York City were tent hospitals in Central Park, a 1,000-bed hospital in the city’s Javitz Convention Center, and a U.S. Navy hospital ship docked in the city.

“We want to empower local communities to also be able to take action and to tap into their local resources,” Verma told NPR. “So, for example, hospitals don’t need to be thinking about only providing services within their four walls.” 

For example, Verma said, there are about 5,000 free standing surgical centers in the country that are not in use because elective procedures have been canceled. That would allow hospitals to separate patients who have coronavirus from those who do not.

“That could be a place where hospitals say, ‘We’re going to direct all of our cancer patients there. We’re going to perform infusion therapy there,’” she explained.

Regulatory Changes Pave the Way for Virtual Care Settings

Other regulatory rollbacks and policy changes by CMS have allowed hospitals and providers to increase their use of telehealth for appointments with patients who have chronic medical conditions, for triaging patients before they arrive at the emergency room, and from pre-screening patients who may have COVID-19.

In March, CMS announced it would temporarily expand access to telehealth for people who are on Medicare. The policy changes mean that Medicare will pay for more than 80 additional services when delivered through telehealth. Among those services are:

• Emergency department visits.
• Initial nursing facility visits.
• Nursing facility discharge visits.
• Hospice.
• Home health.

The new rules let clinicians use telehealth to meet face-to-face visit requirements for patients who are in inpatient rehabilitation facilities, hospice, and home health. In addition, physicians can now use telehealth for check-in visits with both new and established patients. In the past, telehealth could only be used for check-in visits with established patients. 

CMS published a complete list of additional services that can be delivered by telehealth, along with the insurance codes for each service.

Field Hospitals Not Needed As Much As Feared

Field hospitals, such as the one at the Javitz Convention Center in New York City, were initially built and staffed to treat non-COVID-19 patients to leave more room in hospitals for patients who have coronavirus. But after fewer patients were housed there than anticipated, New York Governor Andrew Cuomo asked the field hospitals to start accepting COVID-19 patients. In addition, many of the nearly 1,000 military doctors and nurses who were sent to work at the field hospitals were instead sent to help at many of the city’s existing hospitals.

Telehealth Shows Great Growth After Further CMS Changes

Where telehealth adoption once stalled due to CMS restrictions, it now began to soar. After CMS announced Medicare would be covering additional services via telehealth, many private insurers began to offer similar coverage on their own with great success. For example, Blue Cross Blue Shield of Massachusetts reported processing 180,000 telehealth claims in March 2020. 

In April, CMS issued guidelines that require private health insurers and employer-provided health plans to cover COVID-19 testing at no cost to the patient. The guidelines were issued as part of the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act. The coverage guidelines include telehealth that results in a physician’s order for a COVID-19 test, and the test itself.

One result of the CMS guidelines was a significant increase in the use of virtual care settings via telehealth. Teledoc Health, one of the country’s largest telehealth providers, saw a 50% increase in visit volume in mid-March, according to the Harvard Business Review.  

Telehealth is poised to become a popular and widespread alternate care setting even after coronavirus slows down. This article provides more information about telehealth and how to jumpstart your own telehealth program.

Next Steps

DocASAP is partnering with providers across the country to provide patients with a frictionless way to schedule their telehealth visits online. During the COVID-19 pandemic, this has become a more critical and frequently-requested service.

Request a demo to learn more about DocASAP telehealth scheduling.