Request to extend telehealth benefits for Medicare beneficiaries, and other story starters

About Karen Blum

Karen Blum is AHCJ’s core topic leader on health IT. An independent journalist in the Baltimore area, she has written health IT stories for publications such as Pharmacy Practice News, Clinical Oncology News, Gastroenterology & Endoscopy News, General Surgery News and Infectious Disease Special Edition.

There’s been a small flurry of stories and news updates on telehealth this summer.

On July 26, some 430 health systems, associations and companies sent a joint letter to Congress urging policymakers to extend telehealth benefits for Medicare beneficiaries beyond the COVID-19 public health emergency.

Prior to the start of the pandemic, Medicare only covered telehealth visits for its beneficiaries living in defined rural areas who initiated the call from a provider’s office, according to Kyle Zebley, vice president of public policy for the American Telemedicine Association (ATA), which is co-leading the effort. Thanks to provisions covered by legislation such as the Coronavirus Aid, Relief, and Economic Security (CARES) Act, telehealth became a covered service for all Medicare beneficiaries regardless of area of residence or where calls were initiated. But it was designed as a temporary measure. Unless it’s made permanent, cautioned the ATA and other letter writers, Medicare beneficiaries and providers who have become accustomed to the service could fall off what advocates call a “telehealth cliff.”

The letter, co-signed by groups such as the American Medical Association, Dartmouth Health, Yale New Haven Health System, and Zoom, acknowledged that health care organizations nationwide “have dramatically transformed and made significant investments in new technologies and care delivery models” not only to meet increased demand driven by COVID-19 but also to prepare for future health care needs.

“Without action from Congress,” they wrote, “Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 public health emergency ends. This would have a chilling effect on access to care across the entire U.S. health care system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health.”

“It really is just so counterintuitive to where our technology is now in the 21st century, and it’s because the law hasn’t been updated since 1997,” Zebley said during a recent phone interview, referencing Section 1834(m) of the Social Security Act. Although there has been good support for telehealth from both the Trump and Biden administrations, Zebley said, “there are limits that are going to snap back into place if Congress doesn’t act and the public health emergency ends.”

The ATA and co-authors asked Congress to pay attention to at least four priorities:

  1. Removing restrictions on the location of the patient and provider to ensure all patients can access care from their homes or any location they choose, where clinically appropriate and with appropriate protections and guardrails in place.
  2. Maintaining and enhancing the Department of Health and Human Services’ authority to determine appropriate providers, services and modalities for telehealth — to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services, or to reimburse for multiple telehealth modalities including audio-only services.
  3. Ensuring federally qualified health centers, critical access hospitals and rural health clinics can furnish telehealth services after the public health emergency – to support fair and appropriate reimbursement for these providers and better equip our health care system to address health disparities and provide care to underserved communities.
  4. Removing restrictions on Medicare beneficiary access to mental and behavioral health services – to eliminate a new requirement requiring an in-person visit for mental and behavioral health services prior to a telehealth visit.

Journalists can find interesting stories by interviewing Medicare beneficiaries and their providers currently using telehealth and who may lose that option. Also query lawmakers to understand their support of telehealth usage.

In other telehealth news this summer that might spark story ideas or inform your reporting:

  • Illinois Gov. J.B. Pritzker signed bill HB 3308, requiring insurance reimbursement parity for virtual mental health and substance use disorder services, and authorizing all telehealth to be covered through 2027, according to an article in Healthcare IT News. The bill prohibits insurers from requiring patients to attend in-person visits before telehealth services and from requiring patients to provide a reason for choosing telehealth over an in-person visit. It also expands early intervention services that can be provided through telehealth.
  •  The Agency for Healthcare Research and Quality (AHRQ) is providing a new national map that shows the percentages of households with broadband access, computers and smartphones. You can zoom in to the individual county level in each state.
  •  Lee Health in southwest Florida announced it’s waiving its $49 charge for telehealth visits until further notice. Their service offers consultations and prescriptions (if needed) for common conditions such as colds and flu, sinus infections, rashes and cough.
  • A study published July 30 in the journal Telehealth and Medicine Today by MITRE Corp. and Mayo Clinic, with other partners, looked at the widespread implementation of telehealth during the first year of the COVID-19 pandemic by studying over 2 billion health care claims from private insurers. Over 12 million telehealth claims were processed in April 2020, accounting for about half of total health care claims. Peak levels of telehealth use varied widely among states, the authors said, from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise in use, with the largest claims volume being in behavioral health.

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