Patients will lose access to care if Congress doesn't take immediate steps to expand telehealth permanently, health executives told lawmakers Wednesday.
The expansion of telehealth is long overdue, and Congress needs to take action to ensure temporary policy changes remain in effect once the public health emergency has ended, physician leaders testified Wednesday during a Senate Committee on Health, Education, Labor and Pensions hearing.
Patients have overwhelmingly embraced virtual visits and remote patient monitoring tools, said Karen Rheuban, M.D. a professor of pediatrics at the University of Virginia (UVA) and director of the university's Center for Telehealth.
Several Medicare policies that expand patient access to telehealth services are due to expire at the conclusion of the public health emergency.
Healthcare leaders testifying Wednesday all supported making the temporary changes permanent, including modernizing statutory limitations on originating sites, allowing federally qualified health centers and rural clinics to serve as distant sites and expanding the types of providers who can be reimbursed for telehealth visits as well as the types of services that be offered through virtual care.
The easing of restrictions by the Centers for Medicare & Medicaid Services (CMS) enabled UVA to use telehealth tools to manage high-risk patients in nursing homes, and the organization used remote monitoring to care for vulnerable patients at home.
UVA's Center for Telehealth saw virtual care visits jump 9,000% between February and May, she said.
Congress must act to advance telehealth payment reform particularly through Medicare and Medicaid and encourage alignment by the commercial plans, Rheuban said.
Congress also should increase funding to expand broadband infrastructure to help rural and underserved communities access telehealth services. This would help address geographic and socio-demographic disparities that have led to a healthcare digital divide, Rheuban said.
"It is a health equity issue. Some patients can’t afford reliable broadband," she said.
If Congress and CMS fail to take action, it will result in unnecessarily restricted access to high-quality care, said Joseph Kvedar, M.D., president of the American Telemedicine Association and a senior adviser for virtual care at Mass General Brigham, formerly Partners HealthCare.
Essential telehealth services will abruptly end with the national emergency, and beneficiaries who have come to rely on critical virtual services will be "forced back into a world with restricted access to convenient, digitally enabled care," he said.
Reimbursement for telephone-only telehealth visits also is critical, said Kvedar. Health providers at Massachusetts General Hospital and Brigham and Women’s Hospital completed 605,000 virtual visits in the past three months, and 60% of those visits were by telephone.
"Telephone visits are important to cross the digital divide. We should continue that level of reimbursement to address this underserved population," he said.
The expansion of telehealth services also increases access to care for patients with mental health and substance use disorder issues, and these problems have grown more critical during the pandemic, healthcare leaders said.
Committee Chairman Senator Lamar Alexander, R-Tennessee, said the transition to virtual care during the pandemic represents a "massive change" in the healthcare system.
"We have crammed 10 years' worth of telehealth experience into three months," he said.
Based on the ongoing need for providers to use virtual services to care for patients, Alexander said he supported making two key policy changes permanent.
Physicians should be reimbursed for a telehealth appointment wherever the patient is located, including the patient's home, Alexander said, which would mean extending CMS' waiver on geographical and originating-site restrictions.
Alexander also said he supports extending the policy changes that nearly doubled the number of telehealth services that could be reimbursed by Medicare.
In May, BlueCross BlueShield of Tennessee (BCBST), the state's largest insurer, announced it would make permanent its coverage of virtual visits with in-network providers. It's the first major insurer to embrace telehealth for the long term after the dramatic expansion of the services during the COVID-19 pandemic.
Before COVID-19, BCBST saw utilization rates for telemedicine consistently below 30% for members. Utilization rates have risen dramatically in the past three months. From mid-March to mid-May, the insurer saw 50 times more telemedicine claims than during the same period last year, testified Andrea Willis, M.D., BCBST's senior vice president and chief medical officer.
"It's too early to definitively say that the expansion of telehealth has improved health outcomes, but it has undoubtedly improved access to care," she said.
The availability of telemedicine is likely reducing some inappropriate emergency room and urgent care use, Willis said, although the insurer does not yet have quantifiable data to verify it.
BCBST is gathering data on how the increased use of telehealth services impacts healthcare costs, she said.
"We think we’re going to gain efficiencies by keeping people out of the emergency room and with people getting care who may have foregone medical care; we think, down the line, it will save money," Willis said.
Asked by the committee members about whether the insurer would continue to pay parity for telehealth visits, Willis said BCBST is "not in a rush to abandon that."
"We're looking through the data to make sure that we see efficiencies that we think we’re going to see. We don't want to inject additional healthcare costs into the system," she said.