The Future of Telehealth: Perspectives from a Senate Hearing

The Senate Finance Healthcare Subcommittee recently held a hearing to discuss the permanent implementation of telehealth rules for the Medicare program. While there was unanimous agreement among the senators that the current flexible rules should be made permanent, the panelists themselves had differing opinions on certain aspects of telehealth. This article explores the key points and arguments made during the hearing, shedding light on the future of telehealth in the United States healthcare system.

Expanding Telehealth Coverage

The senators were in agreement that the COVID-19 pandemic has highlighted the importance and transformative potential of telehealth. They emphasized the need to make telehealth services permanently available to Medicare beneficiaries, ensuring the predictability of ongoing care. However, when it came to specific telehealth flexibilities, differing opinions emerged.

One area of contention was the inclusion of audio-only visits as a permanent telehealth coverage option. Dr. Ateev Mehrotra, a professor of healthcare policy at Harvard Medical School, argued against making audio-only visits permanent, advocating for a focus on improving video visits. On the other hand, Dr. Chad Ellimoottil, the medical director of virtual care at the University of Michigan, disagreed, highlighting the importance of audio-only visits for patients with connectivity issues.

Dr. Ellimoottil shared a personal experience where he had to resort to conducting a patient visit over the phone due to connectivity issues. He emphasized that for Medicare beneficiaries in rural and underserved communities, audio-only visits are often the only viable option for remote care. The potential loss of this option if audio-only visits become ineligible for billing could hinder healthcare access for these vulnerable populations.

Beyond the debate surrounding audio-only visits, the panelists discussed other factors that could impact the future of telehealth:

Lack of Coverage Alignment Among Payers

Dr. Ellimoottil highlighted the importance of alignment between Medicare and commercial payers in telehealth coverage. He argued that if Medicare continues to view expanded telehealth coverage as temporary, commercial payers may reduce or eliminate their coverage for telehealth services. Achieving consistency across payers is crucial to ensure widespread access to telehealth for all patients.

Loss of Payment Parity

While the prevailing narrative suggests that telehealth visits have lower practice expenses compared to in-person visits, Dr. Ellimoottil pointed out that practice expenses do not necessarily decrease in a hybrid model. Maintaining physical office equipment and staff salaries remains unchanged, even if a portion of visits are conducted virtually. To avoid potential reimbursement rate reductions, it is essential to accurately evaluate the true cost of providing telehealth services.

Implementation of Clinical Guardrails

The panelists discussed the implementation of guardrails, such as mandating periodic in-person visits for patients receiving telehealth services, to prevent fraud and abuse. Dr. Ellimoottil argued against the imposition of such guardrails, citing data from the Office of Inspector General, which indicated that only 0.2% of telehealth providers showed potentially fraudulent or abusive patterns. Imposing unnecessary barriers for the majority of healthcare providers who use telehealth without exhibiting any patterns of fraud and abuse hinders healthcare accessibility.

Geographic Restrictions and Workforce Shortages

Dr. Eric Wallace, co-director of home dialysis at the University of Alabama at Birmingham, emphasized the need to eliminate geographic restrictions on telehealth. He recounted a personal experience with a disabled patient who lived in close proximity to the clinic but had difficulty accessing in-person care due to physical limitations. Access-to-care problems are not confined to specific regions, and regulations should be revised to accommodate the diverse healthcare needs of both urban and rural populations.

Senator Steve Daines raised another critical issue during the hearing: the severe workforce shortage facing healthcare, with approximately 100,000 nurses leaving the profession in 2021 due to stress and burnout. He asked for insights on how telehealth could help alleviate the workforce shortage. Nicki Perisho, program director at the Northwest Regional Telehealth Resource Center, highlighted the potential of hybrid solutions that combine in-person and virtual care.

The Senate hearing shed light on the future of telehealth in the Medicare program. While there was overall agreement on the need for permanent telehealth rules, differing opinions arose regarding the inclusion of audio-only visits. The panelists also highlighted the importance of coverage alignment, payment parity, and the careful implementation of clinical guardrails. Additionally, the hearing emphasized the necessity of eliminating geographic restrictions and leveraging telehealth to address the healthcare workforce shortages. As the United States navigates the post-pandemic healthcare landscape, these considerations will play a crucial role in shaping the future of telehealth.


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