Telehealth Off to the Races … Or Will Obstacles Persist?

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Those driving the digital health revolution are in a PhD-exclusive world that includes once inconceivable notions such as artificial intelligence, quantum computing, big data analytics, robotics, genomics, biotechnology, virtual reality, etc.

For most everyone else, the manifestation of the digital health revolution is good, old-fashioned telehealth. And telehealth is a big hit.

The pandemic demonstrates that telehealth facilitates and expands access to care, enables clinicians to effectively provide quality care, and that patients – even tech-wary seniors – accept and even embrace the modality.

The question is: When regulatory and reimbursement changes quickly enacted to respond to the COVID public health emergency expire, will telehealth remain and finally become an intrinsic part of the healthcare system? The answer is complicated and much hinges on Congress’s next step.

Before COVID, Medicare limited telehealth to a few services (about 100 codes out of 10,000) and covered those services only if provided in rural areas and only if the “originating site,” the patient location, was in a healthcare facility such as hospital, nursing home or physician’s office. Those limitations and others are included in the Social Security Act, which governs Medicare and, therefore, change requires Congressional action.

To enable access during the pandemic, the Center for Medicare and Medicaid Services (CMS) added telehealth coverage for 144 additional services for all patients, regardless of setting or geography, through the end of the public health emergency. Through rulemaking, CMS then made permanent coverage of 60 of those additional services, effective in January, and created another list of services for which coverage will remain until the end of this year.

However, without Congressional action, geographic, patient-location and other restrictions return for all Medicare telehealth services. Patients in non-rural areas or those who access virtual care from home would no longer be covered by Medicare for such services. As the exception, starting in 2020, Medicare Advantage Plans have the option to offer expanded Part B telehealth services to their subscribers without geographic or facility restrictions.

Bipartisan bills were introduced in both House and Senate at the end of May that would maintain access to telehealth for all Medicare beneficiaries beyond this pandemic. There is bipartisan support in Congress for these measures but scant optimism for passage of the bills soon.

Longstanding concerns about costs – that telehealth utilization would add to, not supplant in-person care – and fraud and abuse have blocked legislative progress for years despite strong backing from providers and patients.

The latest example of government hesitancy came in a May 19 report from the Government Accountability Office, which recommends that Congress hold off on making telehealth expansions permanent until further study determines the full effect of new services on cost, safety and clinical outcomes. “The quality of telehealth services provided to Medicare beneficiaries has not yet been fully analyzed, and evidence from the few existing studies is inconclusive,” the report states.

Perhaps pressure will mount after the pandemic when Medicare beneficiaries, who have come to rely on and appreciate the access, quality and convenience of telehealth, lose those benefits.

Why such focus on Medicare? Because commercial payers typically follow Medicare’s lead in making coverage and payment decisions and policy. And while states are advancing telehealth laws, barriers to a widespread greenlight for telehealth remain. More on state law and payer policy in the next newsletter. For now, enjoy those telehealth visits and keep an eye on debate in Congress. 


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