Federal funding for remote patient visits in jeopardy
As an infectious disease physician and HealthTrust Physician Advisor, William Sistrunk, M.D., has a lot of Medicare patients who live in rural areas. They may live two hours away, so when follow-up on infectious disease treatment is needed, they must drive four hours round trip to Mercy in Springfield, Missouri. Since the early stages of the pandemic, Medicare began reimbursing for many types of telehealth visits—mainly short appointments that could be handled remotely. This alleviated time and other requirements for patients to travel for routine medical care.
That is slated to change after September 30, 2025, when current “telehealth flexibilities” are scheduled to expire. Barring federal action, as of October, health systems and providers will no longer be eligible for many telehealth service reimbursements. That includes the ability to provide these services regardless of the patient’s location—which currently allows patients to receive telehealth in their homes.
How telehealth helps providers & patients
Infectious disease physicians at Mercy also provide telehealth consultations for some of their organization’s smaller and rural in-patient hospitals, offering services that would be harder to obtain without telehealth.
Providing care in a manner that works for patients benefits both parties. “We can make sure patients are getting better at home without them having to travel so far,” says Dr. Sistrunk. “We have a way that may be less expensive for our patients when gas prices are high, and we can help manage our patients well and provide a better-quality oversight of care.”
For orthopedic surgeon William Payne, M.D., Franciscan Health’s Program Director for Orthopedic Surgery and a HealthTrust Physician Advisor, telehealth serves multiple functions in his practice. He has patients who live far away as well as those who travel as snowbirds. They may live in Chicago in the summer and Florida in the winter. With telehealth, he can maintain continuity of their care.
Dr. Payne shares that for his older patients, driving during inclement weather can be dangerous. Some patients also prefer to have postoperative questions or concerns addressed by telehealth, having him look at the incision on camera, answer their questions and make a decision about next steps.
Telehealth can also be used for medication refills that otherwise would require an in-person visit. Dr. Payne also uses the technology for preoperative planning with extended family members. Often family can be included in telehealth appointments, when they otherwise wouldn’t be able to attend an in-person visit because they would have to take time off work.
Another advantage is that the physician can often see the patient in their home environment, which helps in assessing their living situation. “If the patient is about to get a hip replaced or their spine fused, and we spot, for example, a lot of throw rugs, we can advise them to remove the rugs,” Dr. Payne says, as the patient could potentially trip on them, causing additional problems.
Labib Haddad, M.D., HealthTrust Physician Advisor and interventional radiologist at West County Radiological Group and Mercy Hospital in Missouri, adds that not every visit requires an in-person evaluation. An interventional radiologist physician exam may be of limited value prior to a lung biopsy, he says, as there is a plan based on past imaging, presentation to the referring doctor and patient history.
How will lack of reimbursement impact care?
Telehealth is helpful in smaller cities and rural towns that may not have experts in infectious disease, cardiology or rheumatology on staff, Dr. Sistrunk adds. In addition to convenience, through telehealth, all patients have access to the specialists and expert care they need. However, if the government does not extend telehealth coverage for Medicare patients, it may have wide-ranging implications. “We’ll lose that ability to help manage patients in their home,” explains Dr. Sistrunk. “If we can’t do telemedicine, our patients will either have to travel to our clinic more frequently or go to a different type of facility to be able to routinely see a doctor. That includes possibly receiving antibiotic therapy at a skilled nursing facility instead of at home, so a practitioner can keep an eye on them.”
In many circumstances, eliminating Medicare coverage will reduce access to healthcare for some patients, says Dr. Payne. Some practices will require patients to come in, and if patients aren’t able to do that, it can lead to worse outcomes and more costly care. “It will be a big deal,” Dr. Payne adds.
5 Scenarios Where Telehealth Is Effective
- Routine postoperative check-ins
- Medication refills
- Presurgical consultations
with family - Chronic condition management
- Rural patient care & home environment assessments
While practices could opt not to charge for telehealth visits or ask patients to pay out-of-pocket, that’s not a sustainable strategy. “In a Medicare population, most patients are on a fixed income, and they’re pretty price-sensitive,” Dr. Payne says, “and they generally want treatments and visits that are covered by their insurance.”
Ultimately, practices cannot sustain themselves without reimbursement for the visits, Dr. Haddad explains. The patient mix in many radiology practices is 50% to 60% Medicare. If reimbursement is affected too drastically, there can be a devastating downstream effect. There is already a shortage of radiologists, specialists and primary care doctors, and reimbursement issues could hasten the decline in access. He believes that removing telehealth coverage is short-sighted.
Keeping providers informed & patients at the center
Providers and health systems continue to advocate for Medicare telehealth coverage through legislative comment periods. Also, “we make sure to update our providers on the current status so they are aware of the rules and regulations, so everyone can be compliant,” Dr. Payne says.
He hopes that the federal government will realize the value of telemedicine for patients. Dr. Payne has seen a lot of support for continuing with telemedicine from legislators and in the news. “The government wants medicine to be patient-focused, and I agree,” he says. Telehealth is a tool that can help in a lot of situations; not only does it make care more convenient, it provides more patients with access to expertise from specialists.
Share Email CMS, HealthTrust Physician Advisor, Medicare, Policy, Q3 2025, Telehealth
