The pandemic triggered a "seismic change in perception" regarding telehealth, leading to expanded access throughout the United States. And while legislators in December temporarily extended key telehealth flexibilities, political debate on the topic signaled reluctance to make these changes permanent—and there could be implications if they expire, Sarah Tribble writes for Kaiser Health News.

Telehealth coverage may be at risk

In December, President Joe Biden signed a $1.7 trillion spending package that included a two-year extension of key telehealth measures, including coverage for Medicare beneficiaries.

However, the debate surrounding the spending package signaled political reluctance to make these changes permanent, leading federal regulators to investigate how Medicare enrollees use telehealth.

"At issue are questions about the value and cost of telehealth, who will benefit from its use, and whether audio and video appointments should continue to be reimbursed at the same rate as face-to-face care," Tribble writes.

Still, Julia Harris, associate director for the health program at the Bipartisan Policy Center think tank, said the federal extension "basically just kicked the can down the road for two years."

Corey Siegel, a doctor at Dartmouth-Hitchcock Medical Center whose patients were using telehealth before the pandemic, said his Medicare patients were not covered for these visits until Congress and regulators decided to temporarily cover remote medical treatment the same way they cover in-person care.

Before the COVID-19 pandemic, Medicare only covered remote medicine in certain situations. While telehealth was covered for patients in rural areas, they were required to travel to a designated site instead of receiving care in their home.

Then, the pandemic triggered a "seismic change in perception," and telehealth "became a household term," said Kyle Zebley, SVP of public policy at the American Telemedicine Association.

Among the omnibus bill's provisions are "paying for audio-only and home care; allowing for a variety of doctors and others, such as occupational therapists, to use telehealth; delaying in-person requirements for mental health patients; and continuing existing telehealth services for federally qualified health clinics and rural health clinics," Tribble notes.

Notably, telehealth use among Medicare beneficiaries grew to over 32% in April 2020—a significant increase from less than 1% before the pandemic. By July 2021, telehealth use accounted for 13% to 17% of claims submitted, according to a fee-for-service claims analysis from McKinsey & Co.

Josh LaRosa, VP at the Wynne Health Group, noted that concerns over potential fraud and the cost of expanding telehealth have made politicians hesitant to make current flexibilities permanent. According to LaRosa, the report required by the omnibus package "is really going to help to provide more clarity."

In a 2021 report, the Government Accountability Office warned that telehealth use could increase Medicare and Medicaid spending, and the Congressional Budget Office said telehealth could make it easier for people to access healthcare more often, leading to more spending.

Commentary

Telehealth advocates like Zebley claim that remote care does not necessarily cost more. "If the priority is preventative care and expanding access, that should be taken into account when considering costs," Zebley said, noting that an increase in preventive care could lower more expensive spending in the long term.

Siegel and his colleagues at Dartmouth view remote care as a tool to help patients with chronic illness receive ongoing care while preventing expensive emergency care. Remote care "allows patients to not be burdened by their illnesses," Siegel said. "It's critical that we keep this going."

"Patients like it and they want to continue doing it," said Katelyn Darling, director of operations for Dartmouth's virtual care center, noting that many doctors also like telehealth.

If Congress does not continue to fund at-home visits after 2024, Darling said she worries that patients will have to travel to appointments that could have been remote.

"We absolutely need those provisions to become permanent," said Brad Schipper, president of virtual care at Sanford Health. Leaders at Sanford are also closely watching to see whether physicians will continue to get paid for care they provide across state lines.

"During the pandemic, licensing requirements in states were often relaxed to enable doctors to practice in other states and many of those requirements are set to expire at the end of the public health emergency," Tribble writes. Notably, licensing requirements were not addressed in the spending package.

Separately, Sara Gibson, medical director for Little Colorado Behavioral Health Centers, noted that "[t]here are some people who have no access to care without telehealth."

"That has to be added into the equation," Gibson added.

Gibson, a psychiatrist who has used telehealth for decades, said one key question for policymakers moving forward is not whether telehealth is better than in-person care. Instead, it is "telehealth vs. no care," Gibson said. (Tribble, Kaiser Health News, 1/31)