MINOKA, IL — Bill Swick is living with a rare degenerative brain condition that affects his motor skills and ability to communicate. Rather than commuting for an hour to a speech therapist in downtown Chicago, he had been able to schedule virtual appointments from home. But for the past month, he hasn’t been able to access these services.
The ongoing federal government shutdown, now lasting five weeks, has disrupted funding for Medicare’s telehealth program, which compensates providers. Because of this, Swick and his wife are reverting to older techniques to manage the mounting challenges he faces with language and speech.
“It’s really frustrating because we want to keep moving forward with his progress,” said Martha Swick, 45, who has been caring for her husband since his diagnosis three years ago. “I try to arrange his treatments and make things easier for him, but then everything just comes to a halt, and I have to wait.”
Their situation reflects a broader trend affecting millions of patients with Medicare fee-for-service plans who depend on telemedicine options that were expanded during the pandemic.
The waiver that allowed this flexibility has lapsed due to Congress’s inability to agree on funding, even with support from both parties. As a result, healthcare providers are left to decide whether to continue offering telehealth services without promised reimbursements or to halt virtual visits entirely.
This situation is particularly challenging for older patients who often struggle to travel far for medical care.
Swick, whose corticobasal degeneration leads to symptoms reminiscent of Parkinson’s disease, requires assistance with basic tasks like eating and dressing. The stress of navigating traffic for in-person appointments makes them impractical for both him and his wife.
Experts warn that missing even a few therapy appointments can significantly affect the progress of patients with dementia and similar diseases who rely on consistent treatment.
“I really feel like I’ve taken a step back,” Swick admitted during an interview.
Temporary Outage with Significant Impact
Prior to the COVID-19 pandemic, Medicare’s reimbursement for virtual visits was limited, only covering specific circumstances like designated rural areas. However, in 2020, the Trump administration expanded access to telehealth as a response to the health crisis. Medicare started to cover a broader array of telehealth services and dropped geographic restrictions, enabling patients to consult with providers from home.
Although Congress has periodically extended these telehealth provisions, negotiations stalled before the September 30 deadline, leading to the current underfunding.
According to Brown University, this suspension affects approximately 4 million Medicare fee-for-service beneficiaries, significantly impacting at-risk populations.
Swick’s speech therapy sessions are facilitated by Memory and Aphasia Care, a Chicago-based organization. Owner Becky Kayam noted that many clients are located in various states and require therapists with expertise in frontotemporal dementia.
“Now, suddenly, they lack access to telehealth services, missing crucial support for participating in important life activities,” Kayam stated, adding that this could lead to increased isolation and mental health issues.
Telemedicine is beneficial in various healthcare sectors. Dr. Faraz Godushi, a family medicine provider in Tigard, Oregon, mentioned that he uses telehealth for managing chronic conditions. He experienced firsthand that, during the current pause in Medicare telehealth, one of his patients missed a routine visit and ended up in the emergency room.
Susan Collins, a 73-year-old from Murrieta, California, shared that telehealth services were a major relief while she was caring for her late husband, who suffered from a brain disease. Transporting him for appointments was a significant challenge, so home consultations provided a much safer alternative.
Treatment Varies Depending on the Provider
The Centers for Medicare and Medicaid Services has not outright prohibited telehealth services during the funding uncertainty, but has stopped short of assuring reimbursement. This places healthcare providers in a tough spot, as they must weigh their ability to deliver care against the risk of potentially not getting paid.
In Illinois, Kayam had to suspend telehealth for Medicare patients due to the unpredictability of payment. Similarly, Godushi’s clinic will only honor existing appointments but has halted scheduling new ones for Medicare patients until funding is clarified.
Genevieve Richardson, a speech-language therapist in Austin, Texas, has also stopped providing telehealth services to Medicare clients, directing them to local clinics for immediate needs.
Major hospitals are now grappling with whether to continue virtual care for Medicare patients. Dr. Helen Hughes from Johns Hopkins University said they paused scheduling telemedicine visits for Medicare patients as of October 16 because of the ongoing shutdown.
Amid this uncertainty, May Kwon, executive director of the Connected Health Policy Center, emphasized that congressional action is essential to renew telehealth exemptions.
However, with lawmakers divided, expectations for a quick resolution remain low. Martha Swick, while practicing vocabulary with her husband, expressed concern about the dwindling resources available to them. “If I don’t find a solution soon, I don’t know how we’re going to manage,” she said, revealing just a part of the weight she bears as a caregiver.
