When asked about the prospects for long-term telehealth coverage, I often hear people say that permanent expansion is inevitable because "the genie is out of the bottle" or "Congress never takes benefits away."
The truth is they can, and they will, unless we effectively break down persistent misconceptions about the impact of telehealth policy changes. If we can't do it quickly, we should pivot to asking Congress for an extension of the pandemic flexibilities, thereby affording the industry more time to support the formal publication of government studies and peer-reviewed research that bears out the cost-effectiveness, quality and access expansion of telehealth.
Myth No. 1: Lifting Medicare telehealth restrictions will cost the program money
There is a long-standing perception among policymakers that if telehealth is a permanent option in Medicare, beneficiaries will have virtual and in-person visits for the same condition, or seek treatment they would have otherwise avoided, thereby creating excess utilization.
We now have data to effectively dispel this myth. Consistently, across provider type, telehealth proved to be a substitution for in-person care. Overall utilization stayed the same, while telehealth filled in for office visits during peak social distancing periods, and declined as people went back to the doctor's office.
All of the discussion about utilization has crowded out other areas where telehealth saves Medicare money. For example, skilled-nursing facility transfers decreased during the pandemic due to telehealth. Pre-pandemic studies concluded that approximately 60% to 70% of all nursing home transfers to hospitals are unnecessary. Pandemic data from a large telehealth platform that triages SNF patients via telehealth showed that telehealth consultations from March to July of 2020 successfully diverted millions of dollars of SNF transfers. These patients were treated virtually at an overall rate of 91%, including for high-cost falls with injury (84.79%), shortness of breath (66.67%) and acute or chronic pain (95.96%).
Myth No. 2: Patients aren't seeing their own doctors
The myth paints a picture of virtual-only providers reaching patients directly and charging Medicare for unnecessary treatment. In fact, the opposite is true. A large study of patients' telehealth behavior during the pandemic showed that 83% of seniors saw their own provider or someone in the same practice. Only 1.4% of seniors saw someone their insurance company recommended, and a paltry 1% saw a virtual provider they didn't know.
Myth No. 3: Telehealth is uniquely subject to fraud
Sensational press releases by the Department of Justice have created the false impression that telehealth is uniquely vulnerable to criminal behavior. No federal regulator or oversight body has yet issued a comprehensive study of Medicare telehealth claims during the pandemic. The reality is that the majority of fraud instances the DOJ highlighted have nothing to do with telehealth and are instead telemarketing scams aimed at billing for durable medical equipment, diagnostic or genetic tests, opioids or compounding pharmacy.
Myth No. 4: In-person relationship requirements are necessary to mitigate excessive cost and fraud
Requiring patients to first complete an in-person visit constrains the ability of providers virtually treat individuals who are homebound, have transportation challenges, or live in underserved areas. Congress instituted in-person relationship requirements in the first COVID bill in 2020 only to repeal them weeks later. All 50 state legislatures have abolished in-person requirements for telehealth visits, and the American Medical Association and Federation of State Medical Boards have said a physician-patient relationship can be established by telehealth. In-person requirements lower access to care without any meaningful impact on fraud. Cost goes down because of the barrier to people receiving care.
Myth No. 5: The Biden administration has the authority to make the telehealth changes permanent
Congress was responsible for granting the authority that federal agencies needed to allow Medicare to cover telehealth, employers to offer telehealth to part-time and seasonal workers and first-dollar coverage to employees with health savings accounts. These changes will expire with the public health emergency, and the only path to making them permanent is through Congress.
Data can and will break down these myths and enable effective long-term telehealth policy. As advocates we need to bring that evidence to Capitol Hill.
