As we enter a new month, significant changes in Medicare are set to take effect, impacting both patients and providers. One of the most concerning shifts is the expiration of expanded Medicare telehealth coverage, a policy that has been in place since the COVID-19 pandemic. This change threatens to disrupt access to care, particularly for rural and underserved populations, and poses operational challenges for healthcare organizations that have adapted to a more digital-forward model.
At Realistic Strategies LLC, we work closely with healthcare providers, hospitals, and health systems to navigate policy changes that impact patient care and financial stability. The rollback of telehealth flexibilities is one of the most pressing concerns we have seen in recent months, and our goal is to help providers understand the implications, mitigate risks, and take action to ensure continued access to virtual care.
Understanding the Medicare Changes Taking Effect
Starting next month, several key adjustments will reshape how Medicare reimburses telehealth services. The temporary waiver that allowed Medicare beneficiaries to access telehealth visits from home, across state lines, and in non-rural areas will expire. This means that, unless Congress acts, many patients will be required to attend in-person visits for care that was previously available virtually. The return to pre-pandemic policies also means stricter geographic restrictions, with telehealth eligibility largely confined to patients in rural areas who receive care from designated medical facilities.
Additionally, cost-sharing requirements for beneficiaries will increase, adding financial barriers to virtual care. Under the pandemic-era policies, Medicare had waived many out-of-pocket costs for telehealth visits to encourage utilization. The reintroduction of these costs may discourage patients from seeking virtual care, especially those on fixed incomes.
Another significant concern is the potential impact on Remote Patient Monitoring (RPM). While RPM has proven to be a valuable tool in managing chronic conditions and improving patient outcomes, changes in reimbursement structures could make it more challenging for providers to integrate these digital health solutions effectively.
How Telehealth Has Reshaped Healthcare Delivery
The expansion of telehealth during the pandemic brought about transformative changes in healthcare delivery. By removing barriers to access, telehealth allowed patients, especially those in remote areas, to receive care without the burden of travel.
For individuals managing chronic diseases, virtual visits provided a consistent touchpoint with healthcare providers, reducing unnecessary hospital admissions and improving long-term health outcomes. From an operational standpoint, telehealth has streamlined workflows and improved efficiency for healthcare organizations. Clinics and hospitals have leveraged virtual visits to optimize provider schedules, reduce overhead costs, and expand their reach to a broader patient base. These advantages have not only benefited healthcare organizations financially but have also enhanced the overall patient experience.
Patients have become more engaged in their own care, utilizing digital tools for remote monitoring, medication adherence, and follow-up consultations. Despite these successes, the impending Medicare changes place these advancements at risk. The loss of expanded telehealth access could lead to a decline in patient engagement, increased no-show rates, and a resurgence of emergency room visits for conditions that could have been managed remotely.
What Providers Can Do to Advocate for Telehealth Continuation
At Realistic Strategies LLC, we believe that providers play a crucial role in shaping the future of telehealth policy. While regulatory changes may seem beyond the control of individual healthcare organizations, there are several actionable steps that can be taken to push for continued access to virtual care.
Engage in Legislative Advocacy
One of the most effective ways to drive change is through legislative advocacy. Healthcare organizations should collaborate with industry groups such as the American Telemedicine Association (ATA) and the American Medical Association (AMA) to support policy efforts that aim to make telehealth flexibilities permanent. Reaching out to legislators and providing real-world data on the benefits of telehealth can help influence decision-making at the federal level.
Educate Patients and Policymakers
Many patients are unaware that their access to virtual care is at risk. By informing them about these changes, providers can empower patients to advocate for their own healthcare rights. Encouraging Medicare beneficiaries to contact their representatives and share their telehealth experiences can create a groundswell of support for maintaining virtual care access.
Explore Alternative Reimbursement Models
For providers looking to sustain telehealth services despite Medicare cutbacks, exploring alternative reimbursement models is key. Many commercial insurers, employer-sponsored healthcare plans, and direct-to-consumer telehealth platforms continue to offer virtual care coverage. Developing partnerships with these entities can help offset the financial impact of losing Medicare reimbursement.
Adopt a Hybrid Care Model
Healthcare organizations should consider transitioning to a hybrid care model that integrates both in-person and virtual visits. By strategically incorporating telehealth where reimbursement is still available—such as for behavioral health services or remote patient monitoring—providers can continue offering flexible care options without fully depending on Medicare funding.
Looking Ahead: Ensuring Telehealth’s Future
The expiration of expanded Medicare telehealth coverage represents a significant step backward in accessible healthcare. The gains made in telehealth adoption over the past few years should not be erased due to outdated policies that fail to recognize the evolving nature of healthcare delivery.
As a healthcare consulting firm, Realistic Strategies LLC is committed to helping providers navigate these challenges, develop sustainable telehealth strategies, and advocate for policies that support modern, patient-centered care.
Now is the time for healthcare professionals to take a stand. By staying informed, engaging in advocacy efforts, and exploring innovative care delivery models, providers can help shape the future of telehealth and ensure that patients continue to receive the care they need—whether in-person or virtually.
For more information on how Realistic Strategies LLC can support your organization through these changes, visit our website or contact us directly. Together, we can work toward a healthcare system that embraces technology and prioritizes patient access, no matter where they are.