Lawmakers showed bipartisan support for making pandemic-era telehealth flexibilities permanent in Medicare during a Senate subcommittee hearing on Tuesday.
But witnesses noted Congress shouldn’t wait to address the temporary accommodations — some of which expire at the end of next year — to ensure regulatory uncertainty doesn’t push providers away from virtual care altogether.
“If you're investing in a health facility, you need to have the predictability to know that these services are going to be able to be continued well before the expiration date,” said Sen. Ben Cardin, D-Md. “And if you are a patient with a provider and you have a health plan, you need to know that health plan is not going to be disrupted because Congress is a little late in extending the programs.”
Benefits for rural health
Telehealth use soared during the COVID-19 pandemic as providers rapidly boosted their virtual care programs, and regulators loosened rules, like permitting Medicare telehealth visits outside of rural areas or through telephone calls, allow easier access during social distancing.
But, as the public health emergency has drawn to a close, telehealth proponents have pushed to enshrine flexibilities permanently, including with legislation like the CONNECT for Health Act, that was reintroduced in the House and Senate this summer.
Policies that bolster telehealth could improve access to care, especially for disadvantaged groups, the witnesses argued.
Witnesses discussed a range of potential policies, including eliminating geographic restrictions, expanding originating sites, allowing audio-only telehealth, offering payment parity between virtual and traditional care and allowing prescriptions of some controlled substances via telehealth without a preliminary in-person visit.
Rural patients in particular face long travel times to healthcare facilities, which could be further exacerbated by transportation challenges or poor weather, said Sen. Steve Daines, R-Mont.
“Since implementing these flexibilities, we've seen the advantages telehealth offers and the expanded access it provides,” he said. “In rural states like Montana, in parts of Maryland, telehealth has completely changed the game in terms of healthcare access.”
Senators questioned witnesses on cost and quality issues surrounding virtual care — including whether audio-only telehealth would pass muster for all types of care.
For communities that lack consistent broadband internet access, audio-only virtual care might be the only option, Cardin said.
If it’s a choice between audio-only or nothing, audio would be the better choice, said Ateev Mehrotra, professor of healthcare policy at Harvard Medical School. But the country should push to ensure more patients have access to video — and that providers will offer that modality — or we risk creating health disparities.
“I am worried about creating a two-tiered system in the future where the rich get video calls and the poor get phone calls,” he said.
Options for opioid use treatment, payment parity questions
Payment parity between in-person and virtual care is another key question for providers, witnesses said.
“The reality is that, unless your practice is entirely virtual, it's unlikely that your practice expenses have decreased,” said Chad Ellimoottil, an associate professor at the University of Michigan.
But parity could create distortions in the market that give virtual-only clinicians a competitive advantage, pushing some providers to shut down their in-person practices, argued Harvard’s Mehrotra.
Telehealth has also bolstered access to opioid use disorder treatment in the midst of a deadly overdose crisis, witnesses said.
The Drug Enforcement Administration and the HHS announced last month they would extend temporary pandemic-era telehealth prescribing flexibilities for controlled substances through 2024, allowing clinicians to provide the drugs, including medications that treat opioid use disorder, without first conducting an in-person evaluation.
Providers already have to monitor for fraud and abuse for these prescriptions provided for in-person appointments, so that should also apply for virtual care, said Eric Wallace, a professor of medicine at the University of Alabama at Birmingham.
The pandemic offered an opportunity to gather real-world data about telehealth use, and it’s a boon for mental healthcare access, said Sen. John Thune, R-S.D.
“I think that helped illuminate even more the potential way in which we can deliver mental health services via technology,” he said. “And while we've extended the telehealth flexibilities in Medicare until December of 2024, we need to work toward permanent telehealth policies in Medicare.”