Ensuring telehealth policies don't exacerbate existing health disparities proved a major point of concern among lawmakers during a House Ways and Means Committee Subcommittee on Health hearing Wednesday.
Most lawmakers at the nearly three-hour hearing on the future of telehealth were bullish on telehealth's potential, citing how virtual technologies can make healthcare more accessible for patients who face barriers like lack of affordable childcare and lack of transportation that make it difficult to attend in-person appointments, as well as potential cost savings.
"This is a real opportunity—I think we all sense that—to make a big difference," said Vern Buchanan (R-Fla.) at the hearing.
But lawmakers also questioned whether expanded availability of telehealth services could lead to overutilization of healthcare services, open more vulnerabilities to fraud and abuse, and—frequently— whether virtual care would exacerbate racial, gender, income and other disparities seen in healthcare today.
If patients who are unable to access or afford high-speed internet and high-quality devices are left out of the shift to telehealth, it will exacerbate, not shrink, disparities.
"We want to be sure as we move forward and make some of these provisions more permanent, that we have assured good quality of care," said Lloyd Doggett (D-Texas), chair of the health subcommittee. "Depending upon how we implement it, telehealth can either make matters worse or make them much better."
He said he's introducing a bill to extend Medicare telehealth flexibilities promulgated during the COVID-19 pandemic on a limited basis after the public health emergency ends, so that HHS can continue to evaluate telehealth's effect on healthcare utilization, clinical outcomes, care quality and spending, outside of the COVID-19 crisis.
Sinsi Hernández-Cancio, vice president for health justice at the National Partnership for Women and Families, advocated for Congress to "take a pause" and study disparities before making changes to Medicare, while considering health equity as a foundational part of telehealth policy.
"Telehealth is not a panacea," Hernández-Cancio said. "We must understand and guard against potential pitfalls and unintended consequences."
Unequal access to high-speed internet is one unintended way that some populations could be left out of the move to telehealth. But Hernández-Cancio also cautioned against creating a system in which underserved patients are pushed toward low-quality telehealth visits.
She urged Congress to develop telehealth-specific quality measures, which would allow data to be disaggregated and evaluated by race, ethnicity, gender, disability status, and other factors, to ensure there aren't disparities in access or outcomes.
Multiple lawmakers highlighted expanding broadband infrastructure as a lever Congress could pull to improve access to telehealth.
"When we talk about where the government role's is really critical, it's going in to those underserved areas that there's no market to support from (the private sector's) position," said Mike Kelly (R-Pa.). "Can we put more money into broadband, making sure that everybody, across the board, has access to it?"
A limited extension of COVID-19 telehealth flexibilities mirrors a suggestion that the Medicare Payment Advisory Commission made last month to extend such flexibilities for one or two years after the emergency period, arguing that additional information would help to inform which waivers Congress should maintain on a permanent basis.
Not everyone agreed with the idea of a temporary extension for telehealth flexibilities.
Joel White, executive director at the Health Innovation Alliance, argued that telehealth improved access for many patients amid the COVID-19 pandemic. He said based on data he's reviewed, costs didn't "explode" in 2020, suggesting the rapid uptake in telehealth use last year didn't lead to over-utilization as many had feared.
"We must modernize the Medicare program—the silly rules that we've talked about that have been put in place very long ago should be updated to reflect the modern care standards," he said. "Congress needs to move forward and permanently authorize this. If there are challenges or problems going forward, Congress can adjust the law."