There is, of course, work to be done to be able to realize the full potential of tele-emergency care. There must be quality standards, workflows, thoughtful design, and program planning. We also require a comprehensive training and education program that needs to begin in undergraduate medical education (UME) to ensure we have a new generation of physicians who understand how their future practice is going to be affected. Reimbursement must also be codified and kept in law for this practice to be financially feasible.

Much of this is happening. CMS has extended its regulations consistently since the pandemic. The AAMC has set standards for what is required for telehealth education. There are courses to improve digital physical exam and empathy skills. Within EM, ACEP has an active telehealth section that works on advocating and working with other organizations to define and understand the needs of EM physicians in this future practice. Every year more research, programs, and colleagues become involved in telehealth, attesting attests to its expanding worth and utility.

It may seem overwhelming that telehealth will increase the scope of emergency medicine. However, emergency physicians are no strangers to change or innovation. This specialty has always been involved in the community as the front door of the hospital and the connection to all the front-line services. Emergency physicians are innovators, educators, advocates, leaders, researchers, as well as clinicians. All we must do is recognize this as our future practice and incorporate technology and telehealth safely and effectively within emergency medicine.

Emergency Telehealth Creates Reimbursement Challenges

by James L. Shoemaker, JR., MD, FACEP, and David A. McKenzie, CAE

The expanded use of telehealth services from the emergency department (ED) during the public health emergency (PHE) has proven to be an efficient and effective way to expand access to patients who might not otherwise have been able to safely or timely obtain that level of care during the COVID-19 pandemic. ACEP sees the use of telehealth as one avenue to step outside the four walls of the ED to expand the breadth of our specialty and deliverables to our patients. This falls firmly within ACEP’s strategic plan.

U.S. Centers for Medicare & Medicaid Services (CMS) has covered telehealth services from the ED using ED E/M CPT levels 99281–99285 during the PHE, but may not continue to do so, at least at the higher intensity levels of ED E/M services described by CPT codes 99284 and 99285. It’s important to note that CMS reimbursement for levels 99281–85 is the same for in-person and remote visits, as CMS rules do not allow for rate changes based on these differences. These relative value unit (RVU) valuations are the building blocks for health care insurers, and they also cannot alter them. It’s the parity in these codes for reimbursement that makes the reimbursement for telehealth a complex and multifaceted issue.