Congress likely to kick the can on covid-era telehealth policies

Federal lawmakers face a year-end deadline to solidify or scuttle an array of covid-era payment changes for telehealth services that include allowing people to stay in their homes to see a doctor or therapist.

During the hearing in early March, Wenstrup and other House members offered personal anecdotes on how telehealth, home visits, and remote monitoring helped their patients, relatives, and constituents. Wenstrup, a Republican from Ohio who is also a podiatric surgeon and a retired Army reservist, told the audience: "Patients are less anxious and heal better when they can be at home."

Most of the proposals focus on how Medicare covers telehealth services. But the rules affect patients on all types of insurance plans because typically private insurers and some government programs follow Medicare's example. Without congressional action, virtual health care services like audio-only calls or meeting online with specialty doctors — such as an occupational therapist — could end. The bills would also continue to allow rural health clinics and other health centers to offer telehealth services while waiving a requirement for in-person mental health visits.

Telehealth use ballooned in the early months of the covid-19 pandemic and grew into a household term. The practice has become a popular issue for lawmakers on both sides of the aisle.

In one U.S. Census Bureau survey conducted from April 2021 to August 2022, Medicare and Medicaid enrollees reported using telehealth visits the most — 26.8% and 28.3%, respectively. The survey of nearly 1.2 million adults also found that Black patients and those earning less than $25,000 reported high rates of telehealth use. Notably, people of color were more likely to use audio-only visits.

Ensuring access to telehealth services "is the best public policy," said Debbie Curtis, a vice president of McDermott+Consulting, a Washington, D.C.-based health care lobbying firm. "It's the best business outcome. It's the best patient care outcome."

But it's a presidential election year and Congress is a "deadline-driven organization," Curtis said. She expects that Congress will be "kicking the can" past the November election.

Kyle Zebley, senior vice president of public policy at the American Telemedicine Association who also lobbies on Capitol Hill, said Congress “might well be in that lame-duck period." "This is no way to run a health care system on a popular bipartisan issue," he said.

In January, lawmakers — including senators from Mississippi and South Dakota — sent a letter to the Biden administration urging the White House to work quickly with Congress to ensure payments continue for Medicare patients who use telehealth, "especially for rural and underserved communities."

Maya Sandalow, a senior policy analyst for the Bipartisan Policy Center, a Washington, D.C.-based think tank, said lawmakers and policymakers are likely to consider a temporary extension of the payments rather than permanent changes.

"Research is still coming out that covers more recent years than the acute effects of the pandemic," Sandalow said. The center expects to release policy recommendations in the coming months.

Questions being considered include which kind of health care services are best for audio-only and video visits. Sandalow said researchers are also weighing how telehealth can "expand access to affordable, high-quality care while ensuring in-person options remain for patients."

In North Dakota, Sanford Health's David Newman said virtual care is often the only way some of his patients in the western part of the state can get sub-specialty care, such as with behavioral health.

Newman, an endocrinologist and Sanford's medical officer of virtual care, said 10% to 20% of his patients are seen virtually during the summer, as compared with about 40% in the winter months because "the weather can be so bad" that roads are impassable.

In winters past, Newman would sit around "doing nothing for a day" because patients couldn't visit him. Now, he has a full clinic using telehealth technology.

"I tell my patients that if you can make a restaurant reservation or if you can order a pizza online, you can do a virtual visit," Newman said.