Pandemic Shows What PALTC Leaders Have Long Known: Telemedicine Improves Access to Care

August 19, 2020
Ellen Mullally (

AMDA leaders have long advocated for the widespread use of telemedicine in post-acute and long-term care (PALTC). In 2019, for example, they met with lawmakers on Capitol Hill to advocate for regulations and reimbursement to extend the use of telemedicine visits in this care setting based on medical necessity. Just months later, the COVID-19 pandemic hit—and everything changed. Now a new report in the August issue of JAMDA shares how COVID-19 put telemedicine front and center in PALTC and looks at the role this technology should play moving forward.

In Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine, authors Suzanne M. Gillespie, MD, RD, CMD, Steven M. Handler, MD, PhD, CMD, and Alex Bardakh, MPP, PLC, said, “PALTC clinicians and medical directors have believed for many years that their patients would benefit from telemedicine tools to increase access.” The pandemic, the authors noted, “highlighted the need to provide timely access to high-quality medical care, especially to nursing home residents with new or worsening respiratory symptoms.” In response, the Centers for Medicare & Medicaid Services (CMS) removed the once-a-month limitation for subsequent care visits and added initial visits to the list of Medicare reimbursable telehealth services. Essentially, the authors observed, “The agency suspended all face-to-face regulatory visit requirements and allowed them to be completed using telehealth tools.”

Looking ahead, the authors noted that, “Strategic action is needed to more permanently resolve the issues that may limit our progress.” They offered some recommendations to incorporate enhanced telemedicine in PALTC moving forward. These include:

  • Allowing Medicare payments to PALTC clinicians for all skilled nursing facility CPT Evaluation & Management codes using telehealth
  • Allowing medical necessity to dictate telemedicine visit frequency for subsequent care visits
  • Developing and assessing the impact of PALTC workforce competencies for both originating and distal site providers who use telemedicine tools on clinical outcomes
  • Expanding billable telemedicine services for nursing home residents to include e-consultation and additional remote patient monitoring

“Now is the time to quantify the cost, quality, and value of these types of clinical services,” the authors concluded. “Hopefully, we will see 2020 as the turning point in our understanding of how to build effective, financially stable medical care models” that make the most of telemedicine to deliver the accurate, appropriate quality care.

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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.