Will this new legislation permanently change how you practice medicine?

Even as the number of COVID-19 cases hit record highs, experts and legislators are considering whether temporary telehealth services should continue to be covered after the national emergency is over.

Telehealth (or telemedicine) use has skyrocketed since the COVID-19 outbreak began. Individual telehealth procedures and services for private insurance (excluding Medicare and Medicaid) increased by 8,336% nationally in the past year, from 0.15% in April 2019 to 13.0% in April 2020, according to national claim line data from FAIR Health.

But reimbursement for telehealth services at current levels is temporary, and could come to a swift end when the crisis is finally over.

To that end, Rep. Liz Cheney (R-WY) and other sponsors introduced a bill into the House of Representatives on June 25—The Advancing Telehealth Beyond COVID-19 Act—that would continue the telehealth policies implemented through the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

“This bill will allow seniors to utilize telehealth services even after the emergency declaration has ended,” Rep. Cheney said. “Congress has worked with the Trump Administration to remove many of the barriers that prevented seniors from utilizing telehealth services from the safety of their homes. As a result, telehealth use among seniors has continued to rise and this legislation would continue this successful trend well after the pandemic is over, while allowing Medicare to adapt to the ever-changing innovation in medical technology.”

It’s not clear whether the bill would benefit all Americans or only seniors; the text of the bill hasn’t been released yet.

According to Rep. Cheney, the bill would enable the Health and Human Services (HHS) department to lift the geographical and originating site restrictions on Medicare telehealth coverage. These limitations had been in effect until the CARES Act temporarily waived them for all patients for the duration of the pandemic emergency.

The bill would also make permanent the telehealth coverage provided through approved health centers and rural health clinics. In addition, Medicare providers would be allowed to use smart devices and other technologies to remotely monitor and track their patient’s health.

From temporary to permanent?

This bill, and other proposed legislation, arrives amid demands and petitions made by physician and telehealth organizations. These groups have called for telehealth coverage and services to continue at the current rate, and for geographic practice restrictions to remain open, even after the pandemic subsides.

On the same day that Rep. Cheney introduced the telehealth bill, a group of more than 70 medical associations and healthcare organizations—including the American Medical Association, the American Heart Association, National Association of ACOs, and others—sent a joint letter to Congressional leaders urging them to prevent the “sudden unavailability” of telehealth services once the national public health emergency (PHE) is rescinded.

“In particular, we urge you to make the temporary expanded access to digital health and telehealth technology (live audio and video calls)—which is temporary and at least partially expires at the end of the PHE—permanent,” the organizations wrote.

“If Congress does not act before the end of the PHE, coverage and payment of Medicare services furnished using basic, widely available audio video technology will (with a few exceptions) once again be limited to rural areas only, narrowly defined to exclude many rural parts of the country,” their letter stated.

Just a few days afterward, a separate coalition of 340 organizations sent a similar letter to Congressional leaders.

This coalition—which included professional societies, hospital systems, and tech organizations like the American Telemedicine Association, the Healthcare Information and Management Systems Society, the Health Innovation Alliance, the Rural Hospital Coalition, and a multitude of others—praised Congress for expanding access to telehealth services during the COVID-19 public health emergency.

“[T]hese temporary policy changes have allowed 46% of Americans to replace a cancelled healthcare visit with a telehealth service during the pandemic,” the coalition wrote. “Virtual care has provided unprecedented access for patients, but it has become clear that uncertainty as to the future of telehealth under Medicare will halt or reverse further adoption and utilization—to the detriment of both patients and providers.”

“We need your support in ensuring that seniors and providers do not go over the telehealth ‘cliff’—losing access to these critical services when they are still needed by so many,” they urged.

Said Jennifer Covich Bordenick, CEO of eHealth Initiative, in an accompanying statement: “The pandemic provided us with an opportunity to see the benefits of broad telehealth adoption. Virtual care doesn’t just support COVID-19 care, it increases access to communities and consumers for whom traditional office visits don’t always work. Hundreds of organizations want Congress to make these changes permanent because they make sense clinically and financially for both providers and patients.”

‘Bureaucratic barriers’

Members of Congress on both sides of the aisle have made their own rallying cries for continued coverage of telehealth services.

In mid-June, Sen. Ted Cruz (R-TX) and Sen. Marsha Blackburn (R-TN) introduced the Equal Access to Care Act, which would allow doctors licensed in one state to provide telehealth to patients in states where they’re not licensed. This would continue for 6 months after the COVID-19 emergency is declared over.

On July 2, nearly 40 Senators from both parties sent a letter to the directors of HHS and CMS asking them about their plans for the future of telehealth.  

“We write to commend you for the steps you have taken to remove barriers to the broad-based delivery of telehealth services during the COVID-19 pandemic,” the Senators wrote. “We appreciate your commitment to making these temporary telehealth flexibilities permanent—most recently with the proposed rule to permanently extend telehealth changes under the home health benefit—and ask you to provide Congress with a written plan and timeline for permanent administrative changes to Medicare rules governing the provision of telehealth.”

There was no immediate response from HHS or CMS, but an analyst from the latter agency had offered a hint the week before that CMS plans to continue reimbursement for telehealth services indefinitely.

During the American Telemedicine Association’s virtual conference on June 25, CMS analyst Emily Yoder said that CMS is “adding services to the telehealth list and making those permanent,” according to an article in Fierce Healthcare. These changes will appear in the annual proposed Physician Fee Schedule, which is expected to be published in the Federal Register sometime in July.

“Practitioners and stakeholders should watch for that rule and look at the proposals that we’re making and provide comments. Tell us your experiences to help us decide on the flexibilities that we implemented that we want to see made permanent,” Yoder said.