Pandemic Exposes Promise and Pitfalls of Telehealth Policy

Telehealth—also known as telemedicine—transformed virtually overnight from a small, federally authorized program to assist rural patients to avoid lengthy travel for routine consultations with physicians and nurses to an essential service available to all patients to help limit exposure to the coronavirus.

Although the currently declared public heath emergency (PHE), which has to be renewed every 90 days, expires on January 21, 2021, it is expected to be extended when the new Congress and administration are sworn in.

Expansion of telehealth services, first included in the March 2020 COVID stimulus law, have been implemented in an ad hoc fashion during the PHE.  This has revealed a hodgepodge of policies lacking consistency, possibly inhibiting and limiting future access and quality.

“In a matter of a few short weeks, regulatory changes that would likely have taken years to pass were resolved virtually overnight.”

Joe Harpaz, Forbes

Most significantly, the telehealth provisions of the legislation allowed medical providers reimbursement for providing telehealth services to Medicare, Medicaid, and Veterans Administration beneficiaries.  As with most new Medicare policies, private insurers soon adopted the same policies.

Between March and October 2020, the Centers for Medicare and Medicaid Services (CMS) added more than 135 services to the reimbursement list and it is estimated at least 12.1 million (36 percent) of all Medicare beneficiaries have had at least one telehealth consultation.  Medicaid estimated that “more than 34.5 million services were provided…between March and June 2020, an increase of more than 2,600% compared to the same period” last year.

Under current law, the authorization for these services are to expire at the end of the year and legislation will have to be passed before then to extend coverage into 2021.  A number of other funding, regulatory, and technology hurdles will have to be addressed to make them permanent.

Insurance for routine procedures generally cannot cross state lines.  Waivers are, however, often granted depending on the availability of expertise that is not available locally.

Earlier this year, the Federal Communications Commission (FCC) created a $200 million dollar fund to support hospitals and other health care providers with technology support to better deliver telehealth services.

Sen. Lamar Alexander (R-TN) introduced the most comprehensive legislation, the Telehealth Modernization Act (S. 4375), on July 30, 2020 to secure telehealth services for rural communities, eliminate state-line restrictions, increase access to specialists, make permanent many changes in Medicare, link them to home, hospice, and routine services that can be done in patients’ homes, and provide individuals more technological support through tax breaks and grants.  But passage is unlikely given the short time remaining in the lame-duck session and congressional leadership priorities.

As much as telehealth has transformed the healthcare delivery system, it will not replace vital services like diagnostic procedures, infusions, or other procedures like transplants.  In-person care must not be neglected by myeloma patients for fear of exposure to COVID.