This week, Senators Catherine Cortez Masto and Todd Young introduced bipartisanship legislationthe Telehealth Extension and Evaluation Act, to pursue COVID-19-related changes to Medicare coverage of telehealth services beyond the public health emergency (PHE). Expanded access to telehealth has been one of the silver linings of the pandemic, and lawmakers are eager to build on these temporary policies, but caution is warranted. Not all pre-pandemic telehealth regulations were without merit, not all telehealth visits are created equal, and it is not clear that telehealth and in-person care should be treated as entirely interchangeable.
In March 2020, the Trump administration made a number of changes Medicare telehealth policies under the PHE. During the term of the PHE, Medicare will reimburse providers for telehealth visits at the same rates as corresponding office or hospital visits, allow patients to participate from home — without traveling to a designated facility — and drop requirements that patients must have a pre-existing relationship with the provider from whom they are receiving telehealth. The Department of Health and Human Services (HHS) also waived penalties for bona fide breaches of patient confidentiality under the Health Insurance Portability and Accountability Act (HIPAA). As a result, providers and patients can use free video conferencing services. However, these policy changes will end with the PHE.
There’s no reason to expect the Biden administration to be on the verge of ending PHE, but lawmakers are working to ensure those policies remain in place afterward. Cortez Masto/Young bill would extend PHE-related policy changes for two years beyond the end of PHE, while making some additional changes. Their legislation would require at least one in-person visit in the previous 12 months before a provider could prescribe certain durable medical equipment or expensive lab tests, and would require providers to submit details to Medicare about the types of clinicians providing services. through telehealth. These two provisions are based on MedPAC recommendations. The legislation also requires HHS to study the effects of changes to Medicare telehealth coverage policies during the pandemic, which would inform future policymaking.
Telehealth visits have skyrocketed during the COVID-19 pandemic, recent analysis shows. According to the Kaiser Family Foundationvirtual visits accounted for 13% of all outpatient visits from March to August 2020, 11% from September 2020 to February 2021, and 8% from March to August 2021. Although the prevalence of telehealth visits is decreasing, they accounted for fewer half percent of all outpatient visits before March 2020. Patients and providers have embraced telehealth, and virtually no one wants to go back to the policies that existed before the pandemic. That said, simply expanding HHS pandemic-related deregulatory actions probably isn’t the best way to go.. For example, HIPAA’s privacy protections exist for a reason, and giving up on them altogether would be unwise. Furthermore, it is not at all clear that payment parity between telehealth and in-person visits is the right payment policy. Nor is it clear that audio-only telehealth visits are equivalent to video visits in terms of patient outcomes or provider costs. Audio tours are popular with seniors, who are less likely to use video conferencing, but do they offer the same benefit in all cases? And should they be reimbursed at the same rate as video visits?
This pandemic disruption has opened the door to a re-examination of telehealth, but simply extending the current waivers seems pointless. Lawmakers, of course, are seeking more leverage to fully assess telehealth policies before making any changes permanent, while preventing a return to pre-pandemic regulation. Corn two years after the end of the PHE is a long time, and the longer these provisions remain in place, the more difficult it will be to change them later.
Chart review: Video vs. audio usage in telehealth in 2021
Yashashree Marne, Health Policy Intern
The Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services recently released a briefing note on the use of audio and video telehealth services, based on data from the US Census Bureau household pulse survey from April to October 2021. Telehealth services have become increasingly popular during the COVID-19 pandemic. In general, adults aged 65 and older are more likely to use telehealth than those aged 18-24 (22% vs. 16%, respectively), but as the table below shows, there are differences between video and audio only. use of telehealth by age. Young adults aged 18 to 24 were the most likely to use video services for telehealth visits (72.5% of visits), while adults aged 65 and older were the least likely to use video services. video services (43.5%). Audio-only telehealth has been proposed as a way to expand access to healthcare for those who are unlikely to use video services or who have limited ability to access them. The ASPE report, however, points to preliminary evidence that video visits may offer better clinical care compared to audio-only visits. Further research on the value of audio-only telehealth visits versus video visits would help policymakers consider long-term changes in Medicare telehealth coverage.
Tracking COVID-19 cases and vaccinations
Margaret Barnhorst, Health Care Policy Fellow
To track the progress of vaccinations, the Weekly Report will compile the most relevant statistics for the week, with the seven-day period ending on Wednesday of each week.
Sources: Centers for Disease Control and Prevention Trends in COVID-19 Cases and Deaths in the US, and Trends in COVID-19 Vaccinations in the US
Note: The US population is 332,493,652.