The support for permanent changes to Medicare coverage of telehealth has risen drastically in the months since the COVID-19 pandemic began, but Krista Drobac of Sirona Strategies said on a July 23 webinar that stakeholders will have to help make the case that telehealth is cost effective. That cost effectiveness argument may be absolutely crucial if any of the related legislative proposals are to stand up to budget scoring in a time of skyrocketing U.S. budget deficits, she said.

Several bills have debuted in Washington recently that would make changes to Medicare coverage of telehealth more than just temporary responses to the COVID-19 pandemic, but expansions of Medicare coverage can’t be done on the cheap. Drobac, a partner at D.C.-based Sirona, addressed the question on a July 23 webinar sponsored in part by the Advanced Medical Technology Association and the American Telemedicine Association. She pointed out that data on the cost of increased utilization are still difficult to unearth, given the relatively short amount of time that has passed since the beginning of the pandemic.

Drobac urged stakeholders to endorse the Access to Post COVID-19 Telehealth Act (H.R. 7663), adding, “we’ve seen a lot of niche bills come out recently” that take a bite out of the telehealth coverage question from different angles. H.R. 7663 is a more overarching piece of legislation, however, and Drobac said stakeholders should avoid supporting relatively parochial bills that might give Congress an opportunity to think small where telehealth is concerned. Instead, stakeholders should press Congress “to go big” on telehealth, she said.

Data collection is vital if interested parties want to demonstrate to congressional deficit hawks that overall utilization has not risen, and Drobac said the data at present do not support the notion that the exponential increase in telehealth claims in the spring was accompanied by a boost in utilization. Telehealth advocates in Congress would like to see data broken down geographically and demographically, which might highlight some areas of need that heretofore have been undetected. Patient stories are also helpful as they influence legislators’ thinking about how telehealth can be incorporated into routine care, although caregiver stories are also helpful, given the load these volunteer health care providers carry at little or no cost to the taxpayer.

Those aggregations of data must provide answers about cost and quality as well, and despite the clichés such as “can’t put the toothpaste back in the tube” to argue that there can be no reversal of course, supporters of telehealth will also have to provide some answers about fraud and abuse, Drobac said.

Hill supporters ‘groping in the dark’ due to lack of data

Rep. David Schweikert (R-Ariz.) said one of the ideas circulating among supporters on Capitol Hill is that the telemedicine cost question could be tweaked to include the cost and inconvenience to the patient of a return to status quo ante. “We’re actually sort of groping in the dark” on costs due to the lack of data, he said, but there is also some interest in what the next generation of telemedicine-related devices and systems might look like. Among these are the use of wearables for vital sign monitoring, and Schweikert said some players across the various industries involved in health care may see expanded telehealth coverage as a threat to their interests.

Rep. Peter Welch (D-Vt.) said the quality of the patient-physician interaction has, in many instances, been more substantial in telehealth than is often achieved when the patient must wade through traffic and sit in a waiting room. This holds for mental health as well, particularly given that the health care professional can obtain feedback from the patient’s family members as well in telehealth sessions, but Welch highlighted the worries about fraud and abuse, stating, “the goal there is to make sure there are guardrails.”

Welch said the movement in the 1930s to bring electricity to all Americans was based in part on the case for equality of access, adding that Internet access “is as essential as electricity, and that has to be part of our push.”

Physicians not sold on extensions to coverage

Drobac said there is growing support on Capitol Hill to provide another $200 million to the Federal Communications Commission for the agency’s telehealth grants program, adding that the initial bolus of $200 million is already gone. Physicians and physician practice managers are amenable to investing in the equipment and software needed for expanded, permanent telehealth practice, but Drobac said they may be wary of making those investments based on the just-passed Senate COVID spending package. That bill extends Medicare coverage flexibilities to the end of next year, but she said that won’t reassure physician practices that all their telehealth investments will be time and money well spent.

Hal Wolf, president and CEO of the Health Information Management Systems Society, offered some good news about the requisite information technology infrastructure. Wolf said the Medicare meaningful use program has helped physician practices to assemble a large IT infrastructure that will prove useful in this context, adding that it’s difficult to imagine how an expansion of telehealth would be practicable without the meaningful use program’s impact on the proliferation of electronic health records (EHRs). “We need better deployment [of EHRs], no question about it … but the technology is already there,” he said.

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