The COVID-19 pandemic has fueled an unprecedented uptick in telehealth use, from medical and behavioral health services to remote patient monitoring, as federal and state regulators have relaxed certain policy restrictions to increase access to care. Sen. Lamar Alexander (R-Tenn.) recommended in a Senate hearing that certain temporary policy changes, such as elimination of the “originating site” rule and expansion of Medicare- and Medicaid-covered telehealth services, should be lasting to ensure patients retain health care access when the crisis is over.
Alexander said that the health care sector and government have had to cram 20 years of telehealth experience into just three months, thanks to COVID-19, adding that those changes might not have occurred in another 10 years without the pandemic.
“As dark as this pandemic has been, it creates an opportunity to learn from and act upon these three months of intensive telehealth experiences, specifically what permanent changes need to be made in federal and state policies,” he said.
The June 17 hearing of the Senate Health, Education, Labor and Pensions (HELP) Committee was convened to examine the lessons learned from the COVID-19 crisis about the delivery of health care. In April, CMS announced more than 30 policy changes to expand Medicare coverage of telehealth during the pandemic and ensure patient access while reducing infection risks.
Surge in telehealth usage
Alexander called out one Tennessee health system, Ascension Saint Thomas, which went from about 50 telehealth visits per month in February to more than 30,000 a month in April and May, or 45% of all of patient visits.
If 15-20% of the roughly 884 million patient-doctor visits in the U.S. annually continue to occur remotely post-pandemic, that would signal a “massive change” in the health care delivery system. “Our job is to ensure that that change is done with the goals of better outcomes, better patient experiences and at a lower cost,” he said.
Alexander said a third COVID-19-related policy change, which allows doctors to conduct telehealth visits using common video apps on a smartphone, warrants more study because it required the easing of privacy and security rules under the Health Insurance Portability and Accountability Act.
Align CMS, private payer incentives
Karen Rheuban, professor of pediatrics and associate dean of continuing medical education at the University of Virginia, said that to ensure patients don’t lose access to telehealth-supported care, lawmakers need to act quickly to advance payment reforms and align incentives for adoption between CMS and commercial insurers.
“The simplest and most important action for Congress to take is to authorize the secretary of Health and Human Services to make permanent many of the telehealth policies enacted during the public health emergency,” she told the committee. “In addition, Congress should provide support for further broadband deployment, including to the home, as appropriate, to reduce geographic and sociodemographic disparities in access to care.”
Also needed is increased funding for the Health Resources and Services Administration-funded telehealth resource centers and for innovative models of virtual continuing education programs for health professionals to improve patient outcomes, she said.
For Joe Kvedar, president of the American Telemedicine Association, the first step going forward should be to address the current statutory restrictions on patient geography and originating site limitations. “These restrictions are out-of-date and must be modernized to enable Medicare beneficiaries to continue to benefit from telehealth no matter where they are, including in their homes,” he told committee members.
Ensure HHS flexibility on telehealth
Kvedar also urged Congress to ensure that HHS has the flexibility to expand the list of eligible practitioners and therapy services for telehealth reimbursement and to continue funding targeted grant and technical assistance programs, as well as telehealth infrastructure needs.
Andrea Willis, senior vice president and chief medical officer of Bluecross Blueshield of Tennessee, told the committee that telehealth use among its members has risen “exponentially” during the pandemic, from below 30% pre-COVID-19. A key factor in that rise was partnering with in-network providers.
“Because the data is still accumulating, it’s too early to definitely say that the expansion of telehealth has improved health outcomes, but it has undoubtedly improved access to care,” Willis said.
Asked whether government regulation of private insurers posed the biggest hurdle for utilizing telehealth in the future, Kvedar called it a tie. While relaxing the originating site and eligibility restrictions and ensuring parity in Medicare and Medicaid coverage are important, the private sector needs to step up as well, he said. “It would be very difficult to conduct this care model in a world where we got some payment for some things and didn’t get paid for others.”
Rheuban agreed, noting it is very hard for health systems to stand up an expansive telehealth program with multiple payers covering different services. “As much harmonization as possible would be huge incentive for adoption and expansion,” she said.
The panelists also urged lawmakers to support continued reimbursement for telephone encounters, citing a lack of broadband access and computers in many vulnerable communities, including rural, poor and underserved populations. Of roughly 605,000 telehealth visits since March at Massachusetts General Hospital and Brigham & Women’s Hospital, where Kvedar practices, 60% were by phone, he said.
Sen. Bill Cassidy (R-La.), who is also a physician, raised the issue of parity for telehealth vs. in-person visits. Should reimbursement be equal, if telehealth reduces the provider’s overhead costs?
“We did pay parity going into this,” Willis said. “We didn’t feel we could have that kind of conversation in a crisis situation, and we’re not in a rush to abandon that, but we are going to look at the data to make sure that we see the efficiencies we think that we’re going to see.” What payers don’t want to do is inject additional health care costs into the system, she added.