Covid-19 continues to upend the U.S. healthcare system more than two years after the pandemic. While serious indicators such as hospitalizations and deaths have trended down or stabilized across much of the country in recent months, from staffing to vaccine adherence to new crises in the form of mental health and prolonged Covid, Everything continues to plague the whole system. The only port in the storm appears to be the continued increase and reimbursement of telehealth. However, its long-term use as a mainstream healthcare option is in the hands of the U.S. Congress.
Early in the pandemic, when nearly all non-essential, non-Covid in-person care ceased, CMS and Congress quickly opened up the long-banned avenues for virtual care. Care location and geographic restrictions have been lifted, audio-only services are allowed and paid for, and onerous state licensing requirements are waived; even HIPAA has gained new enforcement latitude. As a result, providers and health systems have seen their telehealth visits grow exponentially in a matter of weeks.
Due to the slow expansion of telehealth reimbursement, many providers have been caught off guard and have to scramble to meet the demands of new technology—even systems with more robust telehealth products and capabilities before COVID had to figure out how to handle the surge in online care increase. This rapidly expanding need is challenging, especially as the government links its newfound regulatory clearance to the ongoing federal public health emergency (PHE), which has increased by 90 days since March 2020. volume update.
Each of the 90-day windows has not been updated until the last minute since PHE began, creating stress and uncertainty for providers and health systems. In 2021, a Biden administration’s commitment to provide 60-day notice before PHE expires improves slightly, but still leaves providers uncertain about the future of PHE’s additional telehealth waivers and whether to invest in healthcare IT products and processes .
Advocates of telehealth have been pushing for wider adoption long before anyone has heard of SARS-COV-2, and while progress has been made through 2020, progress has been very slow and incremental. As providers and patients become accustomed to more widespread use of telehealth, advocates see an opportunity for faster, stronger progress.
In the budget passed in March 2022, there are hopes that all exemptions will be extended for one to two years. Negotiations fell apart, however, over the same cost issues that have long hampered telehealth legislation. Finally, Congress passed the 151-day post-PHE extension for most exemptions. Assuming the PHE expires in July, the telehealth services that patients and providers rely on will end in December without further legislation.
Procedurally, that means any further progress will be made during the lame duck session, with success likely to depend on the outcome of the November midterm elections. With control of one or both chambers likely to pass to Republicans and many members on both sides of the aisle retiring, there may be more political will to get something done, or there may be continued opposition.
One political benefit of the telehealth opportunity is that members of Congress who refuse to support long-standing telehealth legislation may prefer to cast the hard — or what they see as expensive — vote after the election, either because they lose or because they have Some breathing room until the next political race.
Advocates are bracing for the political battle that will continue over the summer and escalate after the election. Lawmakers looking to justify continued telehealth demand data on costs, outcomes, access, overhead, and anything else stakeholders can provide. Of particular interest to Capitol Hill is to see how telehealth visits have leveled off after the initial exponential shock to the system in the spring of 2020.
A false belief that increased utilization of telehealth will increase the cost of the health care system continues to prevail in Congress, so data supporting cost savings or neutrality from increased telehealth will be paramount. While Democrats still run both chambers and the White House, they want to know how telehealth can impact health equity in terms of access and outcomes, not new policies to deepen a health care sector exposed by the pandemic.
Telemedicine proponents are most likely to win permanent reform in December by proposing a united front. But there is also a strong possibility that factions will emerge, which will become an adversarial process, with parties seeking to protect their share of the telehealth space.
Certain professions, such as mental health and dermatology, are considered potentially better candidates for continued virtual care reimbursement, and advocates of virtual home health have formed a coalition to protect it. If advocates see fewer opportunities, they may go to the corner and fight for everything they can, even if other professions, nursing settings and practitioners are left out as a result.
Providers, health systems, and patient groups who want to see telemedicine survive post-PHE now need to engage their legislators and associations to demonstrate the need and utility of continued telehealth. Suppliers should also prepare for the worst and prepare for HIPAA enforcement to fall back either way if permanent or long-term policy changes are not passed.
Unfortunately, this 151-day extension doesn’t provide more certainty than the 90-day PHE extension, so vendors still have to make tough decisions about technology investments. However, given how many patients have received telehealth over the past two years, and given growing regulatory requirements around interoperability, providers should assume that technology solutions, EHRs and related platforms will continue to exist and act accordingly.
Photo: elenabs, Getty Images
