By Mario Romao, Global Director, Health Policy
“The onset of COVID-19 has challenged our Nation and the world to rethink the future of healthcare delivery,” U.S. Chief Technology Officer Michael Krastios wrote recently, adding that the public and private sectors have a shared commitment to “emerging technologies that make high quality healthcare more accessible for all Americans.”
Telehealth – the use of electronic information and telecommunication technologies to support long-distance clinical health care – is both one of those technologies and an enabler of additional innovations. For many Americans, telehealth appointments have been a boon, helping to lower the risk of contracting COVID-19 from travelling to visit a healthcare provider. Between April 2019 and April 2020, telehealth consultations saw a staggering 8,336% increase – that’s almost 90-fold.
A recent Issue Brief from the Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation provides further evidence of the role telehealth has played to ensure the continuation of primary care services during the current COVID-19 pandemic. When the pandemic began to substantially impact the U.S., in March, Medicare fee-for-service, in-person visits for primary care fell, while the number of telehealth visits rose to nearly 50% of all primary care consultations. The number of telehealth visits decreased in May but still saw a 350-fold increase from pre-pandemic levels -- 700,000 visits per week in May compared to about 2,000 visits per week in February.
The rise of telehealth consultations is due, at least in part, to several temporary flexibilities in Medicare telehealth benefits. Chief among these has been enabling new and established patients to receive Medicare telehealth and other communications technology-based services wherever they are located, thus removing some of the previous geographic and provider location restrictions. Additionally, roughly 135 new telehealth procedures were added to the list of services payable under the Medicare Physician Fee Schedule, and the list of health care providers capable of offering telehealth services also grew.
Because these and other regulatory changes are temporary and limited to the duration of the COVID-19 pandemic, there is a real risk that Medicare beneficiaries will lose permanent access to nearly all recently expanded coverage of telehealth services unless Congress takes action.
Several bills have been introduced that would make permanent certain pandemic-related telehealth flexibilities under the Medicare program and authorize the Secretary of Health and Human Services to waive or modify application of Medicare requirements to telehealth services during any emergency period.
The Administration is also taking steps to extend telehealth provisions after COVID-19. President Trump recently signed an Executive Order to further expand access to telehealth services, especially in rural communities, and also to extend the availability of certain telehealth services after the pandemic ends.
Intel applauds these efforts and joined hundreds of organizations last June in urging Congress to act to ensure patients and providers don’t fall off the “telehealth cliff” when the pandemic ends.
Several key policy changes are necessary to ensure that telehealth under Medicare doesn’t revert to its pre-pandemic state, to the detriment of both patients and providers:
- Remove Restrictions on the Location of the Patient - Congress should permanently remove the current section 1834(m) of the Social Security Act on geographic and originating site restrictions to ensure that all patients can access care at home and other locations.
- Enhance HHS Authority to Determine Providers and Services for Telehealth - Congress should provide the Secretary of HHS with the flexibility to expand the list of eligible practitioners who may furnish telehealth services, and HHS should maintain the authority to add or remove eligible telehealth services.
- Ensure Federally Qualified Health Centers and Rural Health Clinics Can Furnish Telehealth Services after the pandemic - FQHCs and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act. Congress should ensure that FQHCs and RHCs can offer virtual services post-COVID.
- Make Permanent HHS Temporary Waiver Authority During Emergencies - Congress has given HHS authority under Section 1135 of the Social Security Act to waive restrictions during the COVID-19 pandemic. Congress should ensure that HHS can waive these restrictions permanently to facilitate quick action act during future pandemics and natural disasters.
If any doubts existed about patients’ support for telehealth, a recent survey found 91% of seniors had a positive telehealth experience, and 78% were likely to use telehealth again. Medicare beneficiaries reportedly appreciated the efficiency and convenience of accessing care from home. The extension of the pandemic beyond this summer will provide more momentum for adopting telehealth. But without definitive action from Congress, providers will question investments in telehealth, and the prospect of a “telehealth cliff” for patients will be very real. There are no good reasons to turn back the clock on telehealth.