Congress is facing pressure to ensure the Trump Administration’s relaxed telehealth policies remain after the national pandemic emergency ends, providing more options for patients and providers.
“Our telemedicine program has reduced the burden of travel for Virginians by more than 21 million miles, saved many lives and fostered innovative models of care deliver and workforce development,” testified Karen Rheuban, M.D., a professor of pediatrics at the University of Virginia and director of the university’s Center for Telehealth before the Senate Committee on Health, Education, Labor and Pensions (HELP) on June 17. “The simplest and most important step would be for Congress to give the Secretary the authority to make permanent the telehealth changes made during the public health emergency.”
Chairman Lamar Alexander (R-Tenn.) acknowledged the explosion of telehealth services during the public emergency.
“We have crammed 10 years’ worth of telehealth experience into three months,” Alexander stated at the meeting.
Outdated Rules
One of the emerging legacies of the COVID-19 outbreak has been the transformative effect it has had on telehealth. Before March 13, when President Trump issued his emergency declaration and the Centers for Medicare & Medicaid Service (CMS) removed rules restricting telehealth, consumers and doctors never had a chance to give telehealth a full-fledged try.
Before the declaration, CMS was operating under rules put in place by Congress 20 years ago, which prohibited reimbursement for telehealth services except in areas with an established doctor shortage. Additionally, all telehealth visits had to occur in an approved medical facility. There were also privacy protections in place that restricted doctors from using platforms such as Facetime to communicate with their patients. Under the emergency, these restrictions have been lifted.
Before the emergency, two concerns lawmakers had in permanently lifting restrictions have been a possible increase in health care spending and fraudulent billing. In a May 16, 2019 report, The Commonwealth Fund stated the higher cost concern has been misplaced, based on faulty assumptions by the Congressional Budget Office “that providers would deliver telehealth in addition to in-person services for the same episode.”
The Telehealth Boom
Once Medicare removed reimbursement restrictions in response to the emergency, states and private insurers followed suit and a telehealth boom quickly followed.
Ballard Health, a healthcare system that serves parts of Virginia, North Carolina, and Tennessee, reports 15,000 telehealth visits from April to May, up from 2,400 for the same period in 2019.
A recently released survey by FAIR Health found that the number of telehealth-related insurance claims submitted to private payers increased more than 4,300 percent from March 2019 to March of this year. In the hard-hit Northeast, such claims rose 15,500 percent.
A survey by consulting firm McKinsey & Co. found that growth in telehealth services by consumers rose from 11 percent in 2019 to 46 percent in 2020. McKinsey estimates that telehealth, which had pre-COVID-19 revenues of about $3 billion a year, now has the potential to reach $250 billion annually, with 20 percent of all Medicare, Medicaid, and private care being done virtually.
Broad Based Support
Telehealth popularity has prompted other health care stakeholders to speak out.
The American College of Physicians (ACP) asked CMS to keep telehealth reimbursement rules at bay, at least until a treatment or vaccine for COVID-19 is available.
“Patient care and revenue opportunities afforded by telehealth functionality will continue to play a significant role within the U.S. healthcare system and care delivery models, even after the [public health emergency] is lifted,” ACP President Jacqueline Fincher wrote in a letter to CMS.
In early June, the Federal Trade Commission (FTC) sent a letter to CMS arguing that some of CMS’s policies governing telehealth should be made permanent.
“Telehealth can potentially increase the supply of accessible practitioners and thereby enhance the price and non-price competition, reduce transportation expenditures, and improve access to and choice of quality care,” the FTC wrote.
In May, BlueCross Blue Shield of Tennessee became the nation’s first major insurer to embrace telehealth for the long term. The company announced it would make permanent its coverage of virtual visits with in-network providers. At a June 17 hearing before the Senate HELP Committee, senior vice president and chief medical officer Andrea Willis, M.D., said telehealth is likely reducing some emergency room and urgent care use, although precise data are not yet available.
“It’s too early to definitively say that the expansion of telehealth has improved health outcomes, but it has improved access to care,” Willis testified.
Health care leaders are also urging Congress and President Trump to remove government obstacles to telehealth. An open letter sent June 18 to President Trump by the Galen Institute and Heritage Foundation and signed by 82 participants in the Health Policy Consensus Group, including representatives from Health Care News co-publishers The Heartland Institute and The Goodman Center for Public Policy, states “the federal government should permanently codify pandemic-related regulatory relief, such as removing federal barriers to telemedicine so patients can receive care without leaving their homes.”
Protecting Privacy
Even if Congress removes telehealth regulatory hurdles, McKinsey states the industry will still face challenges over record and data security, work flow integration, reimbursement and patient outcomes.
Despite these hurdles, telehealth has entered a new era, says Robert F. Graboyes, senior research fellow with the Mercatus Center at George Mason University.
“COVID-19 is forcing the medical community to reckon with several revelations,” Graboyes told Health Care News. “First, requiring patients to seek in-person treatment inconveniences them, exposes them to contagion, causes them to delay treatment, and dissuades others from seeking care altogether.
“Second, a high percentage of medical encounters can be safely, effectively delivered remotely; in some cases, telemedicine can be superior to in-person care, thanks to better compliance or lower stress,” Graboyes said. “Third, telemedicine can be convenient and pleasant for doctors, too, by allowing them to reduce commute times, deliver care from vacation homes, and reduce exposure to patients’ infections. My guess is that we’ll never return again to care pre-2020. And that’s a good thing.”
Bonner R. Cohen, Ph.D., (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT).
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