Medicare’s telehealth payment extensions were set to expire, leaving providers and patients in uncertainty. In this bonus episode, Dr. Leo Damasco and Phoebe Gutierrez break down the last-minute extension, the future of telehealth regulations, and how physicians and telemedicine companies can prepare for what’s next.
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At the end of this month, Medicare’s telehealth payment extensions were set to expire, causing widespread concern among telemedicine providers and patients. Many Medicare beneficiaries were already receiving notices that their virtual care options would be discontinued. However, Congress has granted a last-minute six-month extension, temporarily avoiding a major disruption to care.
In this breaking news episode, Dr. Leo Damasco and Phoebe Gutierrez discuss what this extension means, why Medicare is hesitant to make telehealth coverage permanent, and what telemedicine companies must do to prepare for the inevitable regulatory shifts. They explore the challenges of fraud prevention, potential upcoming administrative burdens for physicians, and whether we’ll see another last-minute extension in September—or a long-term solution.
If you work in telemedicine, depend on Medicare-covered virtual care, or run a telehealth business, this episode is a must-listen.
About the Show:
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
🔹 Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemedicine advocate, helping physicians transition to digital health.
🔹 Phoebe Gutierrez – Former state regulator turned telehealth executive, specializing in compliance and sustainable virtual care models.
📩 Connect with Phoebe Gutierrez:
🔗 LinkedIn: linkedin.com/in/pkgutierrez
📧 Email: phoebe@telemedicinetalks.com
Telemed next ep ===
Leo: [00:00:00] Welcome back to telemedicine talks. And today we just wanted to talk about a breaking news, something that just came outta ~the, ~the newsroom here that should be affecting really the entire telemedicine world. Okay? So if you didn't know at the end of this month the telemedicine extension, Medicare, so Medicare paying for telemedicine services was supposed to expire at the end of this month.
Leo: A lot of the telemedicine companies were pretty antsy about it, right? A lot of telemedicine companies are expanding out into, you know, the payer base, the Medicare base, and if these extension or if Medicare was to stop paying for telemedicine, you know, these companies would've been kind of outta luck and just out of a big part of what their plan was, an expected income.
Leo: And so. You know, Congress just came back and extended these Medicare payments extensions. Now, Phoebe, you know way more about this than I do. You know, what's, what's your thoughts on this? Can you bring us back to, you know, [00:01:00] where we were, what happened, and how this affects kind of the telemedicine world in the future?
Phoebe: . Absolutely. So for those who don't know Medicare, which is kind of our, you know, federal program, during the Covid pandemic, just, you know, to increase access and really make sure that people were getting the care that they needed. They basically changed some rules that were written around the telemedicine rules.
Phoebe: And so they were basically allowing access to, people who traditionally were not able to get telemedicine access. They used to have to go, basically, you could get telemedicine access if you were in a clinic. It doesn't make any sense. ~That makes zero sense. Whatever,~
Phoebe: whoever, right? You, yeah. They wanted you to go to a clinic, call into a telemedicine service while you were in clinic ~and, ~and back in the day, that's the only way they were gonna pay for telemedicine services.
I think the theory behind it is that if you're gonna go to your PCP and your p ~CCP ~is gonna refer you to specialty services. And that's the only thing that would [00:02:00] be like an access issue. Right. Okay. Got it. I think like over years we've realized like there's access issues all over the place for all different types of providers.
Phoebe: So, you know, again, like not to kind of derail, but ~you know, I, I, ~you know, it's really like coming up with the times now. Yeah. At the end of this month, the waiver was set to expire, and that means that, , people who were Medicare beneficiaries were supposed to, go back to in clinic to get care and patients were already starting to receive alerts from their provider offices saying like, we can't actually support telemedicine after April 1st because of X, y, and z reason.
Phoebe: And that's because they weren't gonna get, reimbursed for those services. Yeah. So commercial payer and kind of anybody ~in, ~outside of Medicare, you are fine. But if you're ~a, ~a Medicare member like that is. Extremely inconvenient, especially for people who've probably been waiting for these appointments for quite some time.
Leo: ~Right. And, and take it back too, ~right. You know, the commercial payers, ~you know, the, ~the private payers. These are the [00:03:00] people that can actually afford time to go to the clinic to take time outta the day. But, you know, ~it's, ~it's a shame 'cause these Medicare payers, right. These are ~the, ~the demographics that needs a flexibility, right?
Leo: They don't necessarily have the time to take half a day, pull their kids outta school, so forth and so on. You know, these are the folks that are working double jobs, triple jobs, just to make ends meet. And it's been very convenient for them to jump on, ~ their, ~their medical appointment during their lunch hour, , in the car.
Leo: , please drive safely if you're doing that . And you know, ~ it, ~this would hit, ~you know, ~the people that actually needed it the most. Right. So it's kind of a shame.
Phoebe: No, ~a ~absolutely, absolutely. I mean, you look at who are the people that are struggling the most to get to appointments. A lot of these people actually don't have transportation.
Phoebe: They don't have cars. Right. So to them, it's a huge barrier to care. And so. , fast forward Congress has worked to extend the waiver. So for another six months, telehealth is still, allowed and being reimbursed for Medicare. [00:04:00] And I think that there's a couple things that I think are happening, and again, like I'm totally guessing, I have no idea.
Phoebe: I'm gonna have to go squeeze my friend's arm who won't tell me anything about anything that's not public. But what I kind of think is happening, and ~I ~I think that a lot of people don't understand how long these rules take to change. So this, again, was not necessarily like, it's not a state rule.
Phoebe: . ~It, ~it's a Congress issue. So at the end of the day, like Congress needed to kind of act and pass some legislation in order to be able to, permanently make these changes. And, from somebody who's been on the regulator side and has, worked on these regulation packages.
Phoebe: I mean, Leo, they take years like, and I, I don't mean like a year, I don't even mean two, I mean years. Like I worked on a regulation package for three years to get a benefit rolled in to basically change some slight language. And it is just, it's the process. It's, you have to follow the process. There's a million checks and balances.
Phoebe: But if you think about [00:05:00] it like they're trying to do it the right way, , they wanna make sure, because it takes so long, like are we rolling everything we need to into this regulation package? Are we making all the right changes? And so like, my best guess is that they're gonna continue to extend this for as long as they need to, to get those new regulations changed so that they can, you know.
Phoebe: Kind of speed up a little bit and like meet, parody with like commercial and, be able to kind of allow telehealth. I think, COVID really taught us that people want to be seen in their homes. People need to be met where they are to get the care that they, are entitled to.
Phoebe: And I do think that the policymakers see it and understand it, and they're diligently working towards some solution. And I do think the interesting thing, and I know you and I have talked about this at nauseum, is like, Medicare, the biggest thing is fraud. Yeah. And so, one of the reasons why they didn't wanna do, you know, they, you don't necessarily wanna allow it with a blanket.
Phoebe: Is because it's hard to monitor, it's hard to [00:06:00] enforce, and it's really hard to stay on top. And so I, anticipate that they're gonna have some kind of like downstream oversight requirements for any provider group that is doing, kind of like Medicare, telehealth, and there's gonna be probably a lot more administrative and operational burden in terms of like submitting the reimbursement and justifying some of those things.
Phoebe: But at the end of the day, like as long as the patients are able to continue to get. The care that they are entitled to and in the least amount of like, , hurdles. Like, to me, ~that, ~that makes me a happy camper.
Leo: ~Yeah. ~Yeah. And, ~and you know, it, it just, ~ common sense would say, Hey, just extend this out, telemedicine's here to stay Right ~people, ~people know that, but just like you're saying, ~you know, ~one of the biggest barriers of actually extending this out indefinitely is really getting the regulations there , getting the checks there, the balances, because of that fraud issue. ~Right. ~You know, ~you, ~you look it up and that's what, ~you know, ~the biggest hurdle is ~and, ~and why people are so hesitant to actually roll this out now, ~you know?~
Leo: So in September ~are, are we gonna run this? ~Are we gonna run this exercise again? People are gonna freak out a little. Hey, you [00:07:00] know, are the Medicare extensions ~are ~expiring? We don't know if telemedicine is gonna get paid for by Medicare, so forth and so on. ~You know, ~what kind of level of panic or really preparation ~should we, ~should we expect?
Leo: Because again, a lot of these telemedicine companies are now tapping into the Medicare space. Right? And ~you know, ~just looking, ~you know, ~being a practitioner in this space, a lot of the platforms that I'm in. Actually looking into it. Before, when I first started, it was a lot of private pay, a lot of commercial pay, ~right?~
Leo: ~You know, ~maybe private insurances. And because of the trouble, because of these steps and because of the relative pay, the platforms didn't necessarily want to broach that subject. But I think, ~you know, ~everybody's agreed, or it's just a widespread now thought that hey, ~you know, ~in order to survive in this space, we're going to need to enter that space.
Leo: So I know a lot of these platforms have plans in how to get that, you know, ~they're, ~they're credentialing their providers in Medicare and different in states, so forth and so on. But, come September 30th is when ~the exp ~the extension expires, in September. Are, ~are we, ~are we gonna do this [00:08:00] all over again?
Phoebe: I mean, potentially right. To say for, , like, I think ~the, ~the hard part is, is like nobody really knows in terms of kind of like what's happening on the policymaker side, right? So like I think there's a couple things that you can kind of do to prepare yourself. ~I think I. ~One thing that you can really do is just like pay attention to kind of like bills that are being introduced, right?
Phoebe: Like, again, as I said, this is a Congress issue. So before , there's gonna be any sort of like final rule that's gonna kind of like drop down from CMS. Congress would need to act, there would need to be some legislation changes. And I do, again, like the stuff takes a lot of time and I'm sure that they're being really thoughtful in terms of like what they're going to be introducing.
Phoebe: On the flip side, I think that companies that are in this space really need to get their act together. And like, I mean that in terms of like, if you don't have some really strong, , protocols and guidelines for how you're determining medical necessity, how you're doing some of these authorizations, how you're, , [00:09:00] documenting and, really kind of like, solidifying some of those internal processes.
Phoebe: I would really, really, encourage, , all those, , companies to really start paying attention to some of those things. And then I think like last but not least is kind of like on the physician side is like just really get comfortable knowing that if you are working with a company that.
Phoebe: Is kind of continuing in the telemedicine space. I do anticipate that there are gonna be more administrative hurdles that are gonna come down. Unfortunately impacting doctors who are gonna have to, beef up their soap notes, really document all the encounters and probably have to go through a couple more hurdles to either get enrolled or even be kind of like deemed a telemedicine provider in the Medicare space.
Leo: Yeah, because a lot of times, like you were saying, right, ~we, ~we didn't have to necessarily pay attention to that , right? All the processes were internal. Everything was private pay. So, the things that we're used to as brick and mortar doctors as, getting ~this many, ~this many items [00:10:00] in our note, ~you know, ~coding correctly, so forth and so on, weren't necessarily a big issue.
Leo: But I'll be honest, I'm not too excited to have to worry about that in the telemedicine space. But totally understand and hopefully we could find a good kind of efficient solution on how to get around that. Right? Because one of the big things about telemedicine is just, yeah. , ~it was very, ~it was very convenient for us.
Leo: You know, the work was very streamlined, so forth and so on. So, one thing I don't wanna see is, getting bogged down in kind of those requirements where it's just, ~I, I get it, ~I get it, I get why the requirements are there. You know, I get the whole~ you know, the ~fraud issue and everything has to be kind of just laid out there.
Leo: But yeah, just as a practitioner, ~it, ~it's definitely one of those things that kind of weighs you down. So, but yeah. So. Cool.
Leo: Thank you Phoebe, for dropping a lot of knowledge on what's going on. You know, this was a, a big topic that we were paying close attention to. ~We, ~we actually had a whole session about~ about how telemedicine or ~how Medicare ~is, ~is about to go away. And so, no, this is a refreshing kind of, it's not an entire reversal, right?
Leo: Because. , I've been reading up on it [00:11:00] and there's some special provisions that were left out. It's not a hundred percent Medicare doesn't cover a hundred percent of telemedicine. There's things like, follow up , for like heart failure as an outpatient. They're not covering that.
Leo: So we really have to look in the intricacies, but I think this is a good step forward to kind of the acceptance of telemedicine as a whole in the Medicare space. So yeah, ~if, ~if there's other updates breaking news, we'd love to drop it here, check back on the channel for frequent updates. And yeah, we'd love to update you, pbi.
Leo: Any, any closing thoughts?
Phoebe: I would just say that, , we'll continue to, , update everybody. As we're learning more on the policy side and the regulatory side and like some key changes. But , Leo, I always say like, if Medicare is doing it and saying it's a benefit and we are gonna cover it, it's.
Phoebe: ~Is ~, pretty good to consider. Telemedicine is kind of here to stay and even the federal government can agree on that. So I would say like just really validates I think a lot of our internal thoughts [00:12:00] around like the telemedicine space and, the benefits and, and really how it does, , close those care gaps.
Leo: No, ~absolutely. ~Absolutely. And yeah, if you've had questions about it, like, Hey, what's the future? This is a good sign that, yeah, ~this is, ~this is kind of the future of medicine. And yeah, so tune it next time and I would love to see you. Thanks everybody,
Leo: Julio.