Congress presses for some telehealth expansion policies to remain after COVID-19

• Congressional support for permanent expansions in telehealth now includes a senior senator.
• Equalized payment between telehealth and in-person care is among changes that need to be permanent, hospitals say.
• Continued expansive provider use of telehealth will be driven by patient demand, an adviser says.

A senior Senate Republican on Wednesday joined earlier calls from members of Congress for federal healthcare programs to maintain COVID-19-related policy changes that resulted in a historic expansion in the use of telehealth

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, on Wednesday said the federal government should permanently adopt policy changes that aimed to help patients obtain telehealth services during the COVID-19 pandemic.

“As dark as this pandemic event has been, it creates an opportunity to learn from and act upon these three months of intensive telehealth experiences, specifically what permanent changes need to be made in federal and state policies,” Alexander said during a HELP Committee hearing.

Alexander said Congress needs to enact legislation this year to permanently maintain the telehealth policies that have proven effective. He was the most senior Senate leader to call for permanent enactment of the emergency regulatory changes implemented by the Trump administration.

His support followed the introduction of numerous bills in recent weeks to make permanent various elements of the roughly 30 temporary federal policy changes that have encouraged the use of telehealth.

It also followed a June 15 letter from 30 senators urging Senate leaders to pass legislation to keep expanded Medicare coverage of telehealth services. Doing so “where clinically appropriate and with appropriate guardrails and beneficiary protections in place … would ensure that telehealth continues to be an option for all Medicare beneficiaries after the pandemic ends,” the senators wrote.

What policies are needed?

The American Hospital Association has developed a list of policies that would need to be addressed to allow the expanded use of telehealth to continue. Steps include:

• Allowing providers to deliver telehealth services to patients in their homes and other locations and in any area of the country
• Allowing rural health clinics and federally qualified health centers to serve as distant sites that can provide telehealth services
• Making all healthcare professionals eligible to bill Medicare for services provided via telehealth
• Allowing hospitals to bill the Outpatient Prospective Payment System or other applicable payment system for remote services
• Allowing providers to deliver Medicare telehealth services through phones

Illustrating provider experiences with telehealth, LifePoint Health’s utilization grew from a few hundred telehealth visits before the pandemic to more than 28,000 telephone-based visits and 26,000 video-based visits a month, Joseph Kvedar, MD, president of the American Telemedicine Association (ATA), told the HELP Committee.

The 85-hospital health system can now provide specialty consults to its patients using telehealth and has access to providers in other locations to help care for patients in hard-to-serve communities, Kvedar said.

Why telehealth expansion will stay

Amid widespread reopenings and the resumption of in-person services, there is some indication of telehealth’s staying power. For instance, a Commonwealth Fund analysis found the numbers of telehealth visits as of mid-May remained near the peak they reached during the pandemic.

Mark Smith, MD, a senior adviser for Leavitt Partners, said he expects much of the new telehealth volume to remain even after the pandemic. That’s because “the market pressure of patient demand” will force providers to continue to offer it.

“My sense is that once patients have gotten a taste of this, they’re not going back to the old way,” Smith said.

That consumer pressure likely will lead providers to “hybridize their practice” by offering care in person, through email or text, by video and by telephone, Smith said.