by Sean Slone, CSG senior policy analyst
With the need to keep asymptomatic Americans away from health facilities to limit the spread of coronavirus this spring, the federal government and state governments deployed a variety of strategies and regulatory changes to increase access to telehealth. Now many experts are predicting those changes are likely to stay in place as the emergency subsides and efforts are in the works to ensure they do.
As the pandemic took hold this spring, the Centers for Medicare and Medicaid Services (CMS) moved to to expand access by increasing the types of providers who could provide telehealth, allowing them to use different kinds of telehealth modalities including phone-based services, updating coverage rates to pay the same rate as in-person visits and expanding the kinds of originating sites for telehealth visits. States also expanded Medicaid coverage, required private insurance to cover telehealth services and allowed out-of-state providers to use telehealth to treat their residents.
CMS Administrator Seema Verma said recently she expects some provisions her agency extended during the pandemic temporarily to become permanent, noting President Trump “has made it clear that he wants to explore extending telehealth benefits more widely.”
The efforts of CMS also received support from the staff of the Federal Trade Commission in a recent letter.
“Reducing restrictions on reimbursement of telehealth and other telecommunications-based services is essential during the public health emergency to allow health care professionals to provide care safely to Medicare beneficiaries, and to support and enhance the vast expansion of telehealth care that is already underway,” they write.
Patients took advantage of the reduced restrictions and expanded services to a significant degree. U.S. telehealth claims were reportedly up more than 4,000% in March 2020 compared to March 2019. The Northeast, which was hardest hit by the pandemic, saw an increase of more than 15,000%.
Analysts say the pandemic has caused a seismic shift that will mean much more virtual care in the future. A new McKinsey report suggests that the acceleration of telehealth adoption has laid the framework for it to assume $250 billion of U.S. healthcare spending going forward. That’s 20% of all Medicare, Medicaid and commercial operating expenses, office and home health spending. Twenty percent of emergency department visits could be avoided, 24% of healthcare office visits and outpatient encounters could be delivered virtually, and 35% of home health services could be virtualized, the report said.
But telehealth advocates say there is still work to do. The American Telemedicine Association is seeking additional support from Congress in expanding telehealth going forward.
In a late April letter to Congressional leaders, the organization’s CEO Ann Mond Johnson requested that the next federal rescue package include additional funding for telehealth infrastructure and coverage “to ensure that providers, especially those who have traditionally served patients in brick-and-mortar facilities, can rapidly scale to serve patients remotely using telehealth and digital health tools.”
“We must recognize that our ‘new normal’ following this limited COVID-19 public health emergency will necessitate patients’ and providers’ continuing to use telehealth to promote social distancing and to maximize health care resources,” Johnson writes. “The continuation of many temporary policies and the enactment of new, permanent statutory and regulatory changes will need to be considered to ensure patients retain access to modern 21st century care.”
Others say a post-emergency telehealth policy agenda should include a permanent change to the federal Medicare telehealth statute.
“Congress can ensure patient access to telehealth after the pandemic by repealing the ‘originating site’ requirement, which forces patients to travel to certain health care facilities to receive telehealth services instead of allowing them to receive medical attention from … home,” writes Jeffrey Davis, director of regulatory affairs for the American College of Emergency Physicians in a recent op-ed for Medpage Today.
The College of Healthcare Information Management Executives also argues in favor of CMS extending telehealth provisions and implementing permanently things like the waiving of originating site requirements, expansion of and reimbursement parity for audio-only telehealth services, the flexibilities on types of providers allowed to practice telehealth, the waiving of licensure requirements for clinicians practicing across state lines, and allowing localities to define where broadband is deemed insufficient.
Congress & Telehealth
Audio-only telehealth services in particular have proven important during the pandemic in the delivery of mental health and addiction care, particularly for those who live in areas with poor internet connectivity. Some members of Congress are suggesting that the next rescue package expand behavioral telehealth services for a reasonable period following the emergency to collect data on which flexibilities should be continued permanently.
A group of U.S. Senators also has asked Congressional leaders to consider adding more than $200 million to the next COVID-19 relief package to provide increased funding for children’s behavioral health services, including telehealth programs.
“Increasing funding for telehealth capacity and community-based care models can help accelerate children’s access to care they need right now,” the Senators write in a letter to leaders.
Congress could also consider a measure proposed by Illinois Congresswoman Robin Kelly calling for a study of whether telehealth improved access and care outcomes during the pandemic. The Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020 would require the Health and Human Services Department to conduct the study and report back to Congress one year after the emergency has ended.
State Efforts to Make Gains Permanent
Meanwhile a growing number of states are working on measures to make telehealth coverage permanent.
The Rhode Island Senate is considering a bill that addresses telehealth reimbursement rates for in-network providers, originating site requirements and the expansion of approved modalities to include audio-only telephone calls.
In addition, a Colorado Senate committee recently approved a bill to uphold patients’ ability to receive care via telehealth.
Telehealth policy is one of the topics being studied by the What’s Next? Leveraging Innovation Subcommittee, part of CSG’s Healthy States National Task Force, which is made up of state policymakers from around the country. The task force will issue a final report and national framework in December.
- “Removing regulatory barriers to telehealth before and after COVID-19,” Brookings, May 6, 2020.