While lawmakers acknowledge that patients should still have access to telehealth services after the COVID-19 pandemic lapses, they differ on their plans for how Medicare should pay for the access.
During the pandemic, CMS waived more than 200 Medicare rules and issued 230 Medicaid waivers, including allowing out-of-state providers to care for patients virtually and reducing administrative burdens. Approximately 1.9 million people used telehealth to access care in April 2020 at the peak, according to the Government Accountability Office. While patients are still using virtual care more than they did prior to the pandemic, usage has dropped to 700,000 visits per week.
"Telehealth provided certain flexibility during the pandemic so that patients could receive quality care," said Sen. Mike Crapo (R-Idaho). "Making them permanent is a top priority."
Medicare paid the same rates for telehealth and in-person care during the pandemic, but it's unclear if that will be the norm going forward.
CMS' lack of telehealth oversight could cause issues, as expedited processes for provider enrollment could compromise care quality and safety. The Government Accountability Office recommended considering factors such as improving program spending, beneficiary safety, and health equity to protect against these concerns. However, CMS has limited data on the different modalities used to access telehealth, providing little context for the amount of fraud and waste under current Medicare payment models.
Dr. Robert Berenson, a fellow at the Urban Institute, argued that continuing these waivers makes sense in the interim, but lawmakers and policymakers should explore alternatives that affect provider's and patient's telehealth relationships.
"Using the standard fee schedule for telehealth services causes confusion due to payment complaints and counterproductive rules," Berenson said.
Unlike other experts, Berenson said telehealth shouldn't be the primary method of care; it should be in addition to in-person visits which can monitor spending and usage. That approach could be a permanent pay model for primary practice, he said.
Telehealth could also lead to different pay structures, such as using lump-sum payments instead of fee-for-service to pay for specialists, according to the experts.
"The potential of telehealth infrastructure has returns for the American healthcare system, advancing equity, access to healthcare, as well as prosperity for all Americans cannot be understated," said Dr. Narayana Murali,
executive vice president of care delivery and chief clinical strategy officer at Marshfield (Wis.) Clinic Health System and a board member of America's Physician Groups.
Marshfield invested in telehealth before the pandemic with upgraded wiring, a data warehouse and new telehealth platforms, which Murali said gave low-income and geographically isolated patients new ways to interact with clinicians.
But investing in telehealth requires focusing on more than video visits. Experts advocated for Medicare to continue covering audio-only telehealth services. CMS could also collect data to better understand where the government or others need to invest in critical health equity infrastructure, according to Dr. Kisha Davis, a member of the American Academy of Family Physicians' Commission on Federal and State Policy.
"I want telehealth to be a tool in my toolbox based on clinical judgment, not whether I get paid," she said.
