We do almost everything from our smart devices or computers – banking, meetings, bill pay, including paying our medical bills. So why has it taken so long to recognize telehealth as an acceptable way to conduct medical consults? It’s a newer model for delivering care. And let’s not forget about the biggest barrier: reimbursement.

Prior to March 2020, Medicare could only cover limited telehealth consults. With the new 1135 waiver, Medicare can now pay for more types of telehealth visits, including home telehealth consults across the country and not just limited to those who live in designated rural areas. More providers can now get reimbursed for these services, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers. With these changes, there has been an uptick in telehealth consults. This is true for advance care planning conversations as well.

Fear of Spreading the Disease

COVID-19 has made everyone realize the true value of telehealth. Telehealth protects healthcare providers and the precious PPE for those who truly need it to treat those emergent cases. With the fear of increasing exposure and community spread of the disease, telehealth has proven to be one of the only safe ways to conduct consults, especially for those with chronic disease. This was the most vulnerable population pre-COVID, and remains the most vulnerable population during the pandemic. We’re seeing a big shift in how care is delivered for this population: in-person visits are now getting canceled or moved to telehealth visits.

Telehealth for Those with Chronic Disease

An April 2020 report from Evidation showed that 50% of patients with chronic disease worried about visiting their provider in-person, with 10% saying they would skip their visits due to COVID-19. Because of this, a portion of this group will likely end up at the hospital as they worsen, have a higher chance of being admitted, and increase their exposure.

Canceling regularly scheduled visits would make a significant impact on the health of our population: 6 in 10 Americans have one chronic disease; 4 in 10 have two or more chronic diseases. Chronic disease is the leading cause of death and disability, and accounts for much of the $3.5 trillion spend in health care annually. For those that are 65+, they tend to be hospitalized once a year. These people are often managed by a team of primary care physicians, specialists, and for some, assigned care managers by their provider, ACO or health plan. The bottom line – these people make multiple visits to healthcare providers to manage their chronic illness.

While there may be some technological barriers, telehealth visits are becoming the new norm in healthcare, especially for the most vulnerable. Some healthcare organizations are repurposing their staff, giving them a list of patients who have chronic disease, and making calls to these patients. The use of medical devices has also increased the ease and satisfaction of telehealth. Providers are better able to monitor patients. And patients enjoy the convenience of consulting with providers from the comfort of their own homes.

How Are Some Incorporating Advance Care Planning Into Telehealth Visits?

As some healthcare organizations are reaching out to their most vulnerable patients, we’re hearing that they are incorporating advance care planning, asking if they would like to schedule a consult. The loosened telehealth restrictions included advance care planning CPT codes 99497, which covers the first 30 minute conversation, and 99498, which covers any additional 30 minute conversation. Some organizations are repurposing various staff members – nurses, social workers, medical assistants – to conduct and charge for these telehealth consults. CMS is also now reimbursing for advance care planning audio-only telehealth consults, ultimately eliminating the technological barrier that exists with some of the population, namely the elderly.

Although we may continue to see changes, CAPC has shared a 5-minute video outlining legal issues with advance care planning during COVID-19 from Charlie Sabatino of the American Bar Association. While Plan A is the preferred method to eliminate any confusion with the changing requirements, there are other options. One of the main barriers to Plan A is electronic signature. While most providers do not have a way to capture these, our proprietary eSignature technology eliminates this barrier, as it collects all required electronic signatures – clinician, patient, healthcare proxy – no matter where the person may be.

Will We Continue Seeing Support for Telehealth?

We think the answer to this is yes. It’s convenient. It aligns with life in 2020, and even more so during the pandemic as we are all living under social restrictions. We’re seeing health plans like Blue Cross Blue Shield of Tennessee making telehealth coverage permanent. We look forward to seeing who will follow.

About the Author


Vynca, based in Palo Alto, Calif., provides comprehensive advance care planning technology solutions that enable health care organizations to deliver high-quality end-of-life care consistent with an individual’s preferences.

The company helps patients, families and health care providers have meaningful conversations about future care preferences, ensure that wishes are documented accurately and provides real-time access to this critical information throughout the care continuum.