HHS official: 'Cat out of the bag' on telehealth but unclear what changes will stick

A top Department of Health and Human Services (HHS) official acknowledged that telehealth is here to stay after an explosion of use due to COVID-19 but hedged on whether new regulatory flexibility on reimbursement is going to stick around.

“The cat is out of the bag, so to speak,” said Jim Parker, senior adviser for health reform for HHS. “We look forward to helping policymakers, congressional leaders and regulators move the interest in telehealth and healthcare consumerism particularly for rural areas forward in a more permanent way.”

Parker spoke during a Thursday webinar sponsored by the Bipartisan Policy Center on telehealth and rural healthcare amid the COVID-19 pandemic. His remarks come as the healthcare industry is speculating about the future of telehealth changes after increased use during the pandemic.

The Centers for Medicare & Medicaid Services (CMS) gave providers more flexibility to get Medicare reimbursement for telehealth at the onset of the pandemic a few months ago. Since then, telehealth use has exploded as patients were terrified to head to the doctor’s office due to the pandemic.

“We have one physician who wasn’t doing any telemedicine before,” said Alan Levine, CEO of Ballad Health, a healthcare system that serves parts of Virginia, North Carolina and Tennessee. “Even now that they reopened their practice, 70% of visits [are] still telehealth visits.”

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Levine said on the call that from July 2019 through March the system had 2,400 telehealth visits. From April through May, the system has had 15,000 telehealth visits.

But there are lingering questions about the longevity of the telehealth boom. For one, no one knows whether CMS will continue to offer the same flexibility on reimbursement after the pandemic wanes.

“We do face the challenge of where we go from here,” Parker said. “Consumer expectations are likely changed moving forward.”

An open question is whether telehealth increases costs or saves money for Medicare, he added.

“We always knew telehealth was an efficient tool for rural health and by saving travel time and expense, as well as providing quicker access to care,” Parker said. “However, travel time and expense are not covered Medicare expenses.”

Parker noted there are some statutory questions that will require action by Congress too on telehealth.

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The pandemic is a good opportunity to see what works and what doesn’t with telehealth, which should help determine what regulatory changes should become permanent, said Kripa Sreepada, health policy advisor for Sen. Tina Smith, D-Minnesota, on the webinar.

“We are seeing a huge uptick in the use of telehealth services,” she added. “What we need to see is if patients and providers are preferring this as the first step for a visit.”

There are larger considerations on the technology infrastructure, especially for rural areas that may lack access to high-speed internet.

“Which services should we be providing that are audio-only or by video?” Sreepada asked.

CMS said in late April it will grow the number of services it will cover as audio-only telephone visits, including behavioral health and patient education. It also will boost the payment rate for such visits.