House Energy and Commerce health subcommittee chair Rep. Anna Eshoo (D-Calif.) on Tuesday said it's time to make telehealth flexibilities pushed through for Medicare during the COVID-19 pandemic permanent, calling many of the payment policies CMS waived amid the public health emergency "outdated."
Once the COVID-19 public health emergency period comes to an end, Medicare's list of covered telehealth services will only apply to patients living in rural areas and largely won't allow patients to continue accessing telehealth from home, due to restrictions in the Social Security Act. Addressing those restrictions requires action from Congress, not CMS.
Dr. Jack Resneck, Jr., a member of the American Medical Association's board of trustees and a witness at the hearing, asked Congress to remove those Medicare restrictions and to expand broadband access to underserved communities.
Lawmakers have introduced a host of bipartisan bills to tackle that issue recently. Subcommittee members called out the CONNECT for Health Act, which would loosen some of Medicare's restrictions on geographic and originating sites.
"I know that telehealth isn't the silver bullet for the deeper problems that exist in our healthcare system," Eshoo said. "But it's demonstrated great promise for high-quality, innovative care if we intentionally create legislation that fits our nation's needs."
Other lawmakers agreed with the need to expand telehealth access and reimbursement but emphasized the need to consider what medical conditions or specialties are a best fit for telehealth, ways to combat fraud and abuse, and whether lack of access to technology and high-speed internet in certain populations will add to health disparities.
HHS' Office of Inspector General last week said it's conducting "significant oversight work" to assess telehealth services, including fraud, abuse and misuse of such services.
"While more is to come from OIG's research, I believe we should fully examine these issues now, and also revisit once OIG investigations are complete," said Rep. Brett Guthrie (R-Ky.), ranking member of the health subcommittee. "We need to examine ways to continue to allow telehealth, but there are several factors we need to consider and improve on."
In response to concerns over telehealth driving overutilization of healthcare services, Dr. Megan Mahoney, chief of staff at Stanford Health Care and a witness at the hearing, said she hasn't seen evidence of that. From what she's seen over the past year, telehealth has been "largely substitutive, not additive" to in-person care.
About 30% to 40% of Stanford clinis' visits are conducted via telehealth.
"We believe this is our new normal," Mahoney said.
Mahoney called on Congress to address Medicare restrictions so that physicians can continue to treat patients virtually, as well as for CMS to continue adding services to the list of telehealth services it pays for and for the federal government to reevaluate medical licensing restrictions that often stands in the way of telehealth services.
She added that large-scale studies that evaluate telehealth will be needed after the pandemic to continue assessing long-term quality and safety.
Not all experts at the hearing were as enthusiastic.
Frederic Riccardi, president of the Medicare Rights Center, said Medicare beneficiaries' experiences with telehealth amid the pandemic have been "mixed," with some not feeling comfortable with remote care or struggling to find providers delivering care via telehealth.
"With so much unstudied, we view sweeping calls to make the emergency system permanent as premature," Riccardi said. "We must move forward with caution."
He recommended Congress implement a "glide path," so that telehealth flexibilities don't abruptly end with the public health emergency but aren't immediately made permanent. Congress should continue to collect data and study how telehealth has affected patient outcomes and health disparities, as well as what Medicare beneficiaries' preferences are.
Dr. Ateev Mehrotra, an associate professor of healthcare policy at Harvard Medical School, said Congress should consider levers to address telehealth access outside of reimbursement policy. Mehrotra also advocated for a temporary one- or two-year period for CMS to cover audio-only telephone visits while the U.S. accelerates efforts to build broadband infrastructure. Audio-only visits may increase access to care for rural populations without access to high-speed internet.
That would address concerns that telehealth adoption would create a two-tiered system in which "the wealthy get video calls and the poor have phone calls," Mehrotra said.