House health subcommittee chair Rep. Anna Eshoo said Tuesday it's time to make telehealth flexibilities enacted during the COVID-19 pandemic permanent to help close gaps in care.
The Centers for Medicare & Medicaid Services (CMS) waived many telehealth payment policies during the public health emergency, which helped open up access to virtual care. It drove 10.6 million Medicare beneficiaries to use telehealth visits by the end of July, Eshoo said during a Committee on Energy and Commerce health subcommittee hearing.
"The wide adoption of telehealth has been a bright spot during a very dark time in our country," she said. "For the first time, we’ve had substantiative data on the quality and the use of telehealth at scale."
CMS has taken steps to add services to the telehealth list, but a permanent expansion of coverage across the country will require an act of Congress. Only certain areas will continue to get telehealth services after the public health emergency ends.
Many providers would like to see Congress take action to lift legislative barriers, such as removing limitations on originating sites of care, enabling payment parity for virtual visits, and allowing more providers to offer telehealth visits, witnesses said during the hearing.
"Based on experience and what we have learned to-date, these policy changes should be made permanent. They have dramatically improved access to patient-centered care without increasing overall healthcare utilization," said Megan Mahoney, M.D., chief of staff at Stanford Health Care and a witness at the hearing.
She also called for CMS to continue adding services to the list of telehealth services it reimburses and for policy leaders to reevaluate medical licensing restrictions.
But telemedicine’s ability to make care convenient and more accessible may also be its Achilles’ heel, according to Ateev Mehrotra, M.D., an associate professor of healthcare policy at Harvard Medical School.
"The concern is that in some circumstances telemedicine is too convenient and translates into more care and increased healthcare spending," he said. "Policymakers face a difficult challenge in designing an optimal payment and regulatory policy for telemedicine."
One strategy is to move away from fee-for-service to alternative payment models such as full or partial capitation and bundled payments, he said. He also recommended that telemedicine visits be paid for at a lower rate than for in-person visits as virtual care will have lower costs.
Consistency across insurers also is important, he said. "If Medicare covers telemedicine for opioid-use disorder but private insurers or Medicaid do not, then substance use providers will be less likely to embrace telemedicine," he said.
Without proper oversight by policymakers and purchasers, greater use of telehealth could lead to increased fragmentation, duplicative and unnecessary spending, higher rates of fraud and ultimately higher overall costs and worse outcomes for patients, said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health.
Mitchell's organization does not support making permanent any payment parity requirements for Medicare and urges policymakers to focus on a telehealth value-based payment system, she said.
Rep. Frank Pallone Jr., chairman of the Committee on Energy and Commerce, said he continues to have concerns about telehealth driving overutilization of healthcare services and ways to combat fraud and abuse.
"While the convenience of telehealth can help provide critical services to hard-to-reach populations, it can also lead to overutilization or low-value care. It’s important to consider how future policies can encourage the use of high-value care, while, at the same time, discouraging potential low-value care and overutilization in Medicare fee-for-service," he said.
The Department of Health and Human Services' Office of Inspector General said last week it's conducting "significant oversight work" assessing telehealth services during the public health emergency, including fraud, abuse and misuse.
Mahoney said the perception that telehealth may be overused and lead to increased healthcare costs has not become reality.
"Telehealth is a tool in our toolkit and it is largely substitutive and not additive to in-person care," she said. About 30% to 40% of Stanford clinics' visits are conducted via telehealth.
"We believe this will be our new normal going forward," Mahoney said.