MINUKAH, Ill. (AP) — Bill Swick has a rare degenerative brain disease that inhibits his motor and language skills. Instead of the hassle of traveling an hour to a downtown Chicago clinic to see a speech therapist, he benefits from: virtual appointment From the comfort of your home.
But Swick, 53, has been unable to access those appointments for the past month.
of federal government shutdownNow in its fifth week, it has stopped funding the Medicare telehealth program, which pays health care providers for their services. So instead of learning new skills, Swick and his wife are practicing old strategies to help him cope with his increasing difficulties with processing words, stringing words together, and pacing his speech.
“It’s frustrating because we want to continue his journey and his progress,” Martha Swick, 45, who has been caring for her husband since he was diagnosed three years ago, said in an interview from her home in Minoka, Illinois. “I try to get his treatments and everything in place to make his day easier and smoother, but then everything stalls and I just stop and wait.”
Their experience has become commonplace in recent weeks among the millions of patients with Medicare compensation plans who rely on pandemic-era telemedicine waivers. Attend medical appointments from home.
with parliament I don’t agree In the deal to fund the government, the exemption expired even with support from Republicans and Democrats. As a result, health care providers are determining whether they can continue offering telehealth services without guaranteed reimbursement or whether they need to discontinue virtual visits altogether.
As a result, patient populations, which are primarily elderly, have fewer options to seek out specialists or seek help when they are physically unable to travel far from home.
Swick, whose corticobasal degeneration causes symptoms similar to Parkinson’s disease, is unable to feed or dress himself and struggles with balance and walking. Add to that the logistical nightmare of driving into the city while stuck in traffic, and in-person speech therapy appointments just aren’t a worthwhile ordeal for him and his wife.
But experts say missing even a few appointments can hinder the progress of patients with dementia and other degenerative diseases who require continued treatment.
“I feel like I’m taking a step back,” Swick said in an interview.
Temporary outage with significant impact
Before the COVID-19 pandemic, Medicare only paid for virtual appointments under narrow circumstances, such as in designated rural areas or when patients logged in from covered sites such as hospitals or clinics.
The situation changed completely in 2020 when the first Trump administration took office. The scope of telemedicine has expanded dramatically In response to a public health emergency. Medicare began reimbursing a wide range of telehealth visits, removing geographic requirements and allowing patients to receive calls from home.
Congress has periodically extended telehealth flexibilities and was poised to extend them again before the Sept. 30 expiration. But budget negotiations stalled and no vote was taken when the government shut down on October 1, leaving the program temporarily underfunded.
That’s all 4 million Medicare fee-paying beneficiaries According to the Brown University School of Public Health, the use of telehealth is expected to begin in the first half of 2025, but its suspension has already had a huge impact on vulnerable populations.
Swick’s speech therapy services are provided by Memory and Aphasia Care, a Chicago-area company. Owner Becky Kayam said many of her clients live in different cities and states and are looking for therapists who specialize in frontotemporal dementia.
“Now, all of a sudden, they’re without telehealth services and they’re not able to have continued support to participate in activities that are so important to them,” Khayyam said. “Risks include possible social withdrawal and increased depression and anxiety.”
Virtual visits can also be useful in many areas of healthcare. Dr. Faraz Ghodusi, a family medicine provider in Tigard, Oregon, said he uses telemedicine to see patients and help manage conditions such as diabetes and chronic lung disease. During the current Medicare telehealth pause, one of his patients did not receive a routine visit and ended up in the emergency room, he said.
Susan Collins, 73, of Murrieta, Calif., said she found Medicare-reimbursed telehealth appointments “a huge relief” when she was a full-time caregiver for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disease, she struggled to get him out of his wheelchair and into her car for his in-person doctor’s appointments, 90 miles from her home.
“It was much safer to be at home,” Collins said, noting that telemedicine was helpful when her husband needed medication or a consultation about symptoms, but not a full medical exam.
Treatment varies depending on the doctor, leaving patchwork
of Latest guidance The Centers for Medicare and Medicaid Services law does not prohibit health care providers from offering telehealth services during the revocation, but stops short of guaranteeing reimbursement if they do.
As a result, health care providers are deciding whether they can absorb the risk of continuing to treat patients without guarantees that they will be paid for when the government reopens.
In Illinois, Kayam said she had to stop providing telehealth services to Medicare patients because her small business could not handle the volatility of potentially losing payments. Family health provider Godusi said his Oregon clinic is honoring telehealth appointments made before Oct. 1, but won’t be scheduling additional appointments for Medicare patients until funding is restored.
Genevieve Richardson, who runs a speech-language pathology business in Austin, Texas, has stopped providing telehealth services to Medicare customers across the country. She refers them to local outpatient clinics that can provide direct first aid.
Major hospitals are also grappling with whether to offer virtual care to Medicare patients. Dr. Helen Hughes, medical director of the Johns Hopkins University Telemedicine Office, said the hospital initially remained open, but as of Oct. 16, it suspended scheduling Medicare telemedicine visits due to the continued closure.
He said the uncertainty surrounding the exemption was “a complete roller coaster.”
Parliamentary stalemate continues
The government shutdown has entered its fifth week, with no clear end in sight. Meanwhile, Medicare telemedicine flexibility and another Medicare program to offer patients. Hospital-grade care at home Both remain paused.
May Kwon, executive director of the Connected Health Policy Center, said the simplest solution to renewing the telehealth exemption would be for Congress to vote separately.
Federal health care administrators’ hands are “kind of tied,” she said. “So we really need Congressional action.”
But expectations for such action are low as lawmakers are divided and seeking influence.
Martha Swick, who was practicing vocabulary with her husband at home on a recent morning, said if she didn’t find a solution soon, “my resource collection is going to run out.”
“I’m just doing what I can at home as a wife and a caregiver,” she said. “But eventually, you’re really going to need that commitment to come back.”
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Swenson reported from New York.
