We should push for more progress in telehealth

Over the last few months, millions of Americans have used telehealth services — the remote delivery of care and health monitoring using digital telecommunications tools — to get health care. Federal and state policymakers have made it easier to access telehealth during the pandemic to keep people home and safe but there is no reason to slow the momentum after so much progress has been made.

Due to policy changes at the state and federal levels, the use of telehealth has grown faster in the past five months than in the preceding 25 years. During the COVID-19 pandemic: 

• Nearly one in two consumers have used telehealth to replace a canceled in-person appointment

• More than 11.3 million Medicare enrollees accessed care from the comfort and safety of their own homes

• The Veterans Administration provided 1.1 million telehealth visits for veterans

Most of the current telehealth expansions are temporary and will expire with the end of the current public health emergency declaration. But they don’t need to. In fact, 39 senators from both sides of the aisle have introduced legislation that would make some of those changes permanent.

Telehealth can save time, money, and most importantly lives. Studies show that, in normal times, digitally delivered care typically costs only about half of the cost of services provided in doctors’ offices and urgent care clinics and can dramatically reduce unnecessary emergency room trips for patients with chronic conditions.

Until this year, America has been slow to adopt telehealth. The substitution of digital tools for in-person care has long faced skepticism from private insurers and Medicare, as well as some state regulators, who fear widespread adoption will lead to overutilization and fraud. Some physician groups, too, have feared it could disrupt existing practice patterns and have a negative effect on their members’ incomes.

In non-emergency times, Medicare requires that telehealth services originate from inside an officially designated rural health professional shortage area, and from a statutorily allowed setting, which with very limited exceptions does not include the patient’s home. In late January of this year, after the federal Department of Health and Human Services officially declared the spread of COVID-19 to be a public health emergency and Congress provided authority to waive statutory restrictions on telehealth during the pandemic, the Centers for Medicare and Medicaid Services (CMS) used those emergency powers to dramatically expand the telehealth services covered by Medicare and the digital platforms that may be used to provide care via telehealth. The agency also increased the amounts paid for telehealth visits and allowed providers to bill for services provided across state lines.

Doctors and hospitals that have not previously offered telehealth services scrambled to adapt, both to make up for lost revenue as elective procedures were put on hold and to safely maintain patient care. And some providers are restructuring their business models to make telehealth a permanent option. 

But most of the recent policy changes are temporary. In light of the experience of the past few months, and the benefit to patients a consensus seems to be forming in favor of making the changes permanent. Medicare announced that it will make its newly added telehealth codes permanent, something it has the power to do under existing law. And numerous citizen organizations are urging congressional leaders to make other temporary Medicare telehealth changes permanent. 

Telehealth is a way to give Americans better, more convenient access to the health care system if they are stuck at home, in quarantine, live far from good health facilities, or otherwise find it difficult to see a doctor. But it’s not a panacea for all that ails our troubled health care system. Only a limited set of services can be provided via telehealth and it doesn’t answer the deeper political and moral questions about how our society should organized high-quality health care for all Americans. 

Nonetheless, over time it can play an important role in lowering health care costs and expanding access. 

Congress and state legislatures should make telehealth easier to access beyond this pandemic. There is bipartisan that expanding telehealth is a good idea. However, it is not a replacement for a policy that would expand coverage, control costs, and improve health outcomes. But policymakers should reach across the aisle when they can, and this is an opportunity for progress. 

Arielle Kane is the director of Health Policy at the Progressive Policy Institute. Her research focuses on what comes next for health policy in order to expand access, reduce costs and improve quality.