HHS is reviewing possible steps to extend telemedicine flexibilities pushed through during the COVID-19 pandemic, a senior adviser at HHS said Thursday, but eliminating regulatory barriers will require support from other federal agencies, Congress and state governments.
"Looking forward, we do face the challenge of where we go from here," said Jim Parker, senior adviser to the HHS secretary for health reform, during an online panel on telemedicine and COVID-19 hosted by Washington, D.C., think tank Bipartisan Policy Center. "Consumer expectations are likely changed moving forward."
Telemedicine has experienced substantial growth in response to the coronavirus outbreak, helped by a host of regulatory flexibilities. That includes CMS expanding Medicare reimbursement, Congress giving HHS authority to waive originating site requirements for Medicare beneficiaries, and states waiving licensing restrictions.
Many providers want to see those flexibilities continue after the pandemic subsides.
Recent reimbursement expansion allowed Avera Health to "turn up the volume" on its telemedicine network, including standing up a call center in anticipation of a patient surge, said Dr. Jennifer McKay, Avera's medical information officer. That helped the Sioux Falls, S.D.-based system avoid around 50 emergency department visits per day.
"Now that we've had this nice regulation vacation, I think we're hopeful that the cat's now out of the bag, and that we're able to continue doing this very good work," McKay said.
Reducing barriers for telemedicine required coordination and support from Congress, multiple federal agencies, state governments and private payers, Parker noted.
"There was no simple switch the executive or legislative branch could flip to turn on telehealth across the board," he said.
In terms of extending telemedicine flexibilities past the COVID-19 pandemic, Parker said HHS will review data about telemedicine, including its use during the pandemic, to "ensure a soft landing for telehealth, instead of a hard stop."
Next steps for telemedicine "may include looking at what administrative levers we have at HHS," Parker said, but there are also statutory barriers that require intervention by Congress.
One of the main avenues HHS has to encourage continued telemedicine adoption is making recent reimbursement expansions under Medicare permanent. CMS Administrator Seema Verma has suggested some of the telemedicine waivers from the pandemic will become permanent, and in May said President Donald Trump "has made clear that he wants to explore extending telehealth benefits more widely."
There are still issues to assess, such as whether telemedicine use could increase healthcare costs. Telemedicine has been shown to save some costs, like in travel time and expenses, Parker said. But travel time and expenses aren't covered by Medicare.
"We may discover that the direct benefits to patients of tele-care at home has increased the cost of care as a replacement for in-person care," he said. "The technology of telehealth has some costs, and we must determine if convenience for patients justifies that cost."
Parker also stressed the need for stronger broadband infrastructure to support increased telemedicine use.
"We know that how we approach reimbursement for telehealth is important: We can either be the grease that helps the wheel go or we can be the impediment," Parker said. "But even if we get reimbursement right, it's important that nationally we've got the technology infrastructure to support it."
"We could develop a magnificent reimbursement policy for telehealth—and have it stalled if the technology's not there to support it," he added.
HHS has been working with the Federal Communications Commission and Department of Agriculture to build up broadband infrastructure for telemedicine, Parker said.
Kripa Sreepada, health policy adviser to Sen. Tina Smith (D-Minn.), said she's seen bipartisan interest in "pursuing permanent telehealth changes."
Sreepada said the pandemic provides an opportunity to gather data on which of the temporary flexibilities put in place are proving successful and should be made permanent or built upon, as well as whether patients and clinicians who are using telemedicine now find it preferable to in-person care.
A particular point she said needs investigation is which medical specialties and services can be provided via phone call alone, rather than needing a video component.
Expanded telemedicine use during the pandemic offers "a unique opportunity to study what's working and what we should make permanent," Sreepada said.