Many provider groups are clamoring for Congress and federal regulators to permanently expand coverage for telehealth visits once the COVID-19 public health emergency ends.
President Joe Biden’s top health official signaled that the administration supports broadening the use of virtual care in the long term.
“We are absolutely supportive of efforts to give us the authority to utilize telehealth in greater ways,” said Xavier Becerra, Secretary of Health and Human Services (HHS) during an interview with The Washington Post.
“We want to make sure that we don’t leave anybody behind and that telehealth is available to all Americans, universally, and that includes making sure quality broadband is out there for all communities, whether a rural part of the country or an inner-city poor area,” Becerra said.
Telehealth use spiked during the pandemic after the Centers for Medicare and Medicaid Services (CMS) gave more flexibility for providers to get reimbursed by Medicare for such services. These changes, along with expanded coverage from commercial insurers, helped to open up access to healthcare services, telehealth advocates say.
CMS has said that it will need Congressional intervention to make some of the flexibilities permanent.
According to the Alliance for Connected Care, more than 43 new bills related to telehealth and remote patient monitoring have been introduced over the course of the pandemic.
As these bills work their way through Congress, the Biden administration wants to ensure equity and accountability if coverage for virtual care is expanded.
“We want to make sure Americans are getting a valuable service. We want to make sure that these providers are providing a service that might not have been available had we not had telehealth and also results in better quality services and treatment. We don’t want to be billed for things that don’t result in better health for Americans,” Becerra said.
There is a risk that a digital divide could widen health disparities in the U.S. as telehealth use grows, according to some experts.
“Not under my watch,” Becerra said in response to a question about health inequities. “We’re going to do everything we can to include everyone.”
He added that a person’s zip code should not determine their access to virtual care services. “This is a new type of healthcare, and it could be audio or visual. There are circumstances in which you don’t need a smartphone, any phone might be enough. We want to make sure we take advantage of all the technologies that let us communicate with each other and provide healthcare when possible.”
HHS also will ramp up oversight to ensure digital health and virtual care services are rolled out equitably across the country, he said.
“Accountability is very important. We’re going to do a lot of ‘bird-dogging,’ a lot of oversight,” he added.
Jack Resneck, Jr. M.D., president-elect of the American Medical Association (AMA), said the physician organization also supports expanding the telehealth waivers.
“I don’t think my patients want to go back to the way things were a year and a half ago when this wasn’t an option,” said Resneck, a dermatologist who practices in the San Francisco Bay Area, during a separate interview with The Washington Post.
He noted that expanded insurance coverage during the pandemic drove the uptick in telehealth use.
“Within a matter of weeks, government insurers, Medicare and Medicaid, and private commercial insurers were able to open this up and turn on coverage for telehealth that hadn’t existed before the pandemic and allowed us to provide care for patients,” Resneck said.
The AMA is among many industry groups urging Congress to permanently remove a section of Medicare policy, called 1834M, that sets geographic and originating site restrictions. Eliminating those restrictions would enable Medicare patients to do virtual health visits with their doctors from their homes after the public health emergency ends, he said.
Physician licensure flexibilities are a thornier issue, both Becerra and Resneck said.
During the pandemic, regulators lifted geographic limitations and waived licensure requirements to let patients schedule telehealth appointments with doctors across state lines.
Rather than keep those changes in place, Resneck said he supports rolling back the out-of-state licensure flexibilities when the public health emergency ends. Physician licensing enables states to hold doctors accountable for the care they provide, he said.
Becerra agreed, saying state-by-state physician licensure creates more accountability for the healthcare system.
“The farther you go away from the direct connection from patient and provider, the more difficult it will be to provide accountability quickly and fairly for the patient. If your doctor is 30 miles away and you live in rural America, we can track down that doctor, but if your doctor is 3,000 miles away, that’s a tougher sell for a consumer who is trying to get accountability for a service that was not properly provided,” Becerra said.
There are other approaches to enable doctors to care for patients across state lines, such as interstate medical licensure compacts, according to Resneck.