More telehealth data requested before making relaxed rules permanent

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Congress should have a clearer picture of how patients are using telehealth before making the relaxed pandemic-inspired rules permanent, Medicare advisers say.

Lawmakers recently extended telehealth changes for up to five months after the public health emergency was declared over. This expansion of the omnibus spending package alleviates telehealth advocates’ concerns about a “telehealth cliff” or the abrupt cutoff of most virtual care coverage.

Many medical groups have called on lawmakers to make telehealth more permanent because it improves health care access and convenience. But concerns about quality, cost and fraud are holding lawmakers back on telehealth, which typically enjoys bipartisan support.

“We are hesitant to draw too many definitive conclusions” from data from 2020, “the year in which the entire healthcare system was severely locked down,” said James Mathews, executive director of the Medicare Payment Advisory. Commission, which advises Congress on Medicare. . Once the commission has data from 2021 and 2022, “we will have an idea of ​​what telehealth looks like in a more benign environment, a clearer picture of who uses telehealth and its implications for access to care” , said Mathews.

Telehealth wasn’t widely available before the pandemic because the Centers for Medicare & Medicaid Services only reimbursed visits that met a “perfect storm of criteria,” said Thomas Ferrante, a partner at Foley & Lardner LLP and a member of the company’s telemedicine team. The Social Security Act payment rules limit telehealth to patients who live in rural areas and initiate their visits at eligible sites like hospitals. Only certain types of providers could provide telehealth services.

The CARES Act, a cross-sectoral Covid-19 relief bill, allowed physicians to initiate telehealth treatment with patients in their homes during the public health emergency. Medicare beneficiaries used telehealth 88 times more in the first year of the pandemic than they used the year before, according to a report by the Office of Inspector General of the Department of Health and Human Resources. Social services.

The pandemic has led to an “unintentional lab experiment” testing the usefulness of telehealth, which never would have seen such widespread adoption without reimbursement flexibility, Ferrante said.

Benefits

Democrats and Republicans in Congress support telehealth because it has increased access to care for their constituents, especially early in the pandemic when people were hesitant to receive in-person care.

More than 28 million Medicare beneficiaries used telehealth in the first year of the pandemic, more than 2 in 5 beneficiaries, according to the OIG report.

Telehealth can encourage people to access needed care when they would otherwise put it off due to a long commute to a doctor’s office, said Krista Drobac, partner at healthcare consulting firm Sirona Strategies and executive director of the Alliance for Connected Care. The modality is ideal for post-acute care records and chronic disease management, she said.

“There are also cost savings in places like nursing homes,” Drobac said. “Instead of putting a patient in an ambulance and sending them to the nursing home, a telehealth provider can actually solve more problems on sight.”

The five-month extension of the omnibus package “provides certainty not only to providers of what they are able to do, but also to patients that they are still able to receive some of these services through these modalities,” said said Mei Kwong, executive director of the Center for Connected Health Policy.

“As patients benefit from these changes and access to healthcare expands, we hope Congress sees the wisdom in making these changes permanent,” said Gerald Harmon, president of the American Medical Association, in a statement.

“There is no doubt that telehealth saves lives,” HHS Secretary Xavier Becerra said at a recent press conference. HHS “is going to work as aggressively as possible to get as much authority as possible,” he said.

Hesitations

Data on quality of care and patient outcomes for remote treatment versus in-person treatment “would be critical to discussions about making any or all of these waivers permanent,” Mathews said. MedPAC will work on comparing population-level data on hospitalizations and emergency room visits from 2019 to 2022 and 2023, once telehealth “become stable,” to see if those visits could have been avoided due to of the presence of telehealth, Mathews said. .

In order to get clear data, lawmakers should maintain telehealth for at least a year after the public health emergency, Mathews said.

Proponents say the quality data is already clear. “We provide the same care, and in some cases, enhanced care when we see patients where they are,” said Shabana Khan, a child and adolescent psychiatrist and member of the American Psychiatric Association’s telepsychiatry committee.

Cost is also a barrier to adopting more permanent legislation. “Telehealth is expensive, so I think there are concerns about the financial impact on the Medicare program as a whole,” said Claire Ernst, director of government affairs for the Medical Group Management Association. If people who otherwise would not have received care do so via telehealth, it is more taxing on the program.

More data is also needed to assess whether patients follow up a virtual visit with an in-person visit, which drives up costs, Drobac said.

Fraud is still a concern for the Medicare program, and some lawmakers may be wary that fraud is easier to commit virtually, said Morgan Reed, executive director of the Connected Health Initiative. Digital medicine has actually “reduced fraud because there are better fingerprints” like length of visit and IP address than physical records, Reed said.

Future action

Providers are investing in telehealth, which will likely increase regardless of the future of Medicare reimbursement. “Consumer demand is there now,” Ferrante said, and some telehealth provider prices are more competitive than the patient co-pay.

But “they would definitely invest more” if they knew how long the flexibility would last, Ferrante said. “Why invest when you don’t know if the service you provide today will be paid for tomorrow? »

The omnibus package requires MedPAC to study expanding telehealth services, which would mean changing Social Security law, Ernst said. The report is due June 15, 2023. A separate HHS OIG report on fraud prevention measures is due the same day.

Congress could continue to offer temporary telehealth waivers until that deadline, particularly if lawmakers’ decision-making depends on analysis by MedPAC and the OIG, Drobac said.

The five-month extension “is enough time to really continue to work with our bipartisan champions in both the House and the Senate and with the administration to make sure Congress acts again,” said Kyle Zebley, vice president of public policy at American Telemedicine. Association.

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