That the pandemic period provides a major headwind to telehealth adoption is an undeniable reality. According to some reports, prior to COVID-19 fewer than 40 percent of patients with a chronic condition had a telehealth visit; post-pandemic that number had risen to more than 60 percent. According to CDC data, telehealth use leapt up between 50 and 154 percent during the early days of the pandemic in Q1 and has persisted as an increasingly important factor in the provision of care, particularly to patients at risk of being cut off from essential health services.
As for how that push to telehealth was created by the pandemic, that is both obvious and not so obvious. In an attempt to slow the spread of the virus, physicians and healthcare providers shut down their offices. Patients, however, still needed access to care, and telehealth services stepped in as a proxy for the in-person services that had been shut down — a proxy boosted heavily by the CDC and World Health Organization.
“It’s great when other organizations are spreading that message for us, which is what we have now when the World Health Organization, CDC and others are actually recommending telemedicine as a great method to seek care,” telehealth provider Doctors On Demand CEO Hill Ferguson told Karen Webster in an interview early on in the pandemic period.
Consumers found that telehealth was in fact better than a good substitute for a physical office visit with the parking, waiting and various associated friction points that simply aren’t present with a virtual visit. The patient consumer has been won over.
The less obvious part of the push the pandemic gave telemedicine is the change to regulations to motivate more providers to offer it. The Centers for Medicare and Medicaid (CMS) temporarily waived geographic and site-related restrictions allowing broad use of video and audio-only telemedicine visits that the CMS would now allow to be reimbursed by Medicare and Medicaid. Those restrictions have been continually wavering as the pandemic has worn on and the public health emergency period has been extended. That shift, along with changes made by private insurers to reimburse telehealth services at an equal rate to office services, made providers much likelier to offer telemedicine services to their patients.
And while the consumer side of this story seems pretty stable — consumers who try telehealth tend to like it ,with 95 percent reporting they will utilize it again after their first visit — the provider side is far less so. Because those CMS changes were only put in temporarily and could end just as soon as vaccine distribution is wide enough to declare the pandemic period over. And should the reimbursement line be suddenly cut off, it remains to be seen how enthused physicians will remains to be proffering telehealth services.
There are, notably, moves to head off that outcome in Congress.
“It’s time to make Medicare reimbursement for telehealth permanent,” said House Committee on Energy and Commerce Health Subcommittee Chairwoman Anna G. Eshoo (D-Calif.) in a hearing last week. “Telehealth isn’t the silver bullet for the deeper problems that exist in our healthcare system, but it’s demonstrated great promise for high quality, innovative care if we intentionally create legislation that fits our nation’s needs.”
Support And Concerns
While most healthcare debates rapidly devolve into partisan squabble in the halls of Congress, telehealth is the rare issue with bipartisan reach. Ranking Republican committee member Brett Guthrie of Kentucky said the “genie is out of the bottle” when it comes to telehealth services — and that instead of trying to hold it back, the plan going forward needs to be putting the right guardrails in place so that fraud does not become an endemic issue on telehealth platform.
Because telehealth’s virtual remove from a physical space makes fraud a concern. Other House members raised the specter of overuse and a worry that if telehealth is so easy to access and get fully reimbursed, patients might go a little crazy and overuse the platforms successfully running up expenses.
Ateev Mehrotra, MD, MPH, a healthcare policy researcher at Harvard Medical School in Boston, testified before the subcommittee that full telehealth access should not be maintained because it “can be too convenient in some circumstances.”
Instead, the CMS should focus on reimbursing telehealth care in “high-value applications,” he said.
There were also concerns that telehealth purely focused on video conferencing ignores the fact that many Americans lack access to the broadband technology that would make it a truly accessible option for patients everywhere.
Nonetheless, there are two pieces of legislation now moving through the House to take on this issue. The Protecting Access to Post-COVID-19 Telehealth Act would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and continue reimbursement for it for 90 days after the end of the pandemic. It would also permanently allow HHS to expand telehealth in any disaster situation. That bill has bipartisan support and is considered to have strong odds of passing the full House and moving onto the Senate.
The second piece of legislation goes further to keep telehealth services locked in and even expand them. The Telehealth Modernization Act would permanently remove Medicare’s geographic and originating site restrictions and pull in more types of providers to deliver telehealth, including physical therapists and other allied health professionals. That bill is largely supported by Democrats and is not considered as a strong a lock for passage.
How much this will affect telehealth services remains to be seen. As always that answer might come down to the specific service. Some services PYMNTS has interviewed in the past year are fully direct-to-consumer (D2C) and don’t take payments from insurance companies public or private. Reimbursements are irrelevant to them because they don’t accept them anyway.
For firms more tied to the “normal” world of healthcare payments, however, the answer will likely be a bit more complex and dependent on how Congress chooses to move.
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