Key Takeaways: Emergency waivers for telehealth are likely to be made permanent by end of year, perhaps before August recess, as recommended by Sen. Alexander. This change sets the stage for broad adoption of telehealth services by hospitals and physicians practices. One possible amendment could be an extension of audio-only rembursement to address digital divide in rural areas and among certain demographics. At at least initially, reimbursement will remain at parity with in-person visits to encourage adoption.
Today Senator Lamar! Alexander (R-TN) held a hearing on which, if any, of the COVID-19 emergency provisions related to telehealth should be extended. Sen. Alexander endorsed two emergency provisions for permanent adoption:
- Permitting reimbursement regardless of patient location (the "originating site" rule)
- Extending Medicare and Medicaid reimbusement for more providers and services including ER screening, initial nursing facility visit and therapy services
At the end of the hearing Alexander notes that the Committee should probably consider how state licensure restrictions can be addresed and look at ways to encourage private payer adoption. Sen. Alexander did not appear supportive of extending emergency waivers for use of non-HIPAA compliant commercial platforms such as Facetime and Skype
Witness included:
Karen S. Rheuban, M.D. Professor Of Pediatrics, Senior Associate Dean Of Continuing Medical Education, And Director University of Virginia Karen S. Rheuban Center for Telehealth
Joseph C. Kvedar, M.D. President, American Telemedicine Association, Professor, Harvard Medical School Virtual Care, Mass General Brigham, Editor, npj Digital Medicine
Sanjeev Arora, M.D., M.A.C.P., F.A.C.G.Distinguished And Regents’ Professor, University Of New Mexico Health Sciences Center Founder and Director, Project ECHO/ECHO Institute
- 9000% increase in telehealth visits during COVID-19
- Reconfigured 100 isolation rooms to accomodate telehealth and communication with families
- Developed home program to monitor quarantines
- Developed program for high risk congregate living situations
- Patient satisfaction is very high
Rheuban - Recommendations
- Authorize HHS to make changes to telehealth program to keep it flexible
- Further broadband deployment
- More funding for HRSA
- Deploy telehealth for training
Kvedar - Background
- Associated with Mass Gen and Brigham & Womens. System conducted 605k telehealth visits in March. Post-Covid, expect 250k per month v 1,600 in February.
- Improves no show rate
- Set up telehealth system using ZOOM prior to COVID-19 outbreak
Kvedar - Recommendations
- Make permanent all emergency provisions; patients and providers will demand it
- Modernize current geographical limitations
- Give HHS flexibility to add or terminate providers and services
- Need more broadband
- Streamline provider licensing
- Do not abrubtly end current provisions as we prepare for outbreaks
Willis - Background
- For commercially insured, BC/BS of TN relaxed restrictions and paid in-network at parity with in-office visits
- Not in a rush to change parity but looking at data and will re-evaluate.
- Before COVID-19, utilization was below 30% but has expanded exponentially
- Key was working with in-network providers
- Improved access to care
- Used for primary, specialists and ED visits
- Redirected ED use by 50%
Willis - Recommendations
- Don't allow system to become fragmented with sweeping changes to licensure. Secret to success is payers working with in-network physicians
- Need broadband and a secure platform
- Need to keep audio only reimbursement due to limitations on broadband
Other comments from Senators
- Mental health services is an area of focus because it is "all about the conversation." Patients don't need to endure a visit but still improves access. Must have parity in reimbursement with general medical and with in-office visits
- Vulnerable populations was another area of focus. Vitals can be checked remotely, can support discharge of complex patients; overcomes geographical divide
- Expanded education for providers to allow greater access to specialization, especially in rural areas
- More consideration to remote monitoring
- Limitations: first time patients are not a good use
- Need to let specialty societies provide best practices
- Need to address DEA waiver limitations for prescribing controlled substances
Let us know if you have any questions. We watch Congress so you don't have to.
Emily Evans
Managing Director – Health Policy
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