How we can avoid the 'telehealth cliff'
Photo: Anchiy/Getty Images
It's become common knowledge, at this point, that the flexibilities enabled by the federal government at the start of the COVID-19 public health emergency prompted an atmospheric jump in telehealth use.
At the same time, the question has continued to loom: What will the future of those flexibilities – and, by extension, telehealth – look like?
"Last year, electronic health services played a critical role in keeping vulnerable Americans, particularly our seniors, safe from exposure while continuing to provide the care they need," said Sen. Tim Scott, R-S.C., in his opening remarks for a panel at the American Telemedicine Association's annual conference and expo this month.
"As our country recovers, we have a responsibility to make sure our telehealth efforts move forward, not backward," he added.
Panelists made clear that much of that responsibility lies with elected officials.
"If Congress does not act before the public health emergency ends, regulatory flexibilities that now ensure all Medicare beneficiaries maintain access to telehealth will go away," said Kyle Zebley, director of public policy at the ATA, who moderated the panel.
Emily Yoder, an analyst at the Centers for Medicare and Medicaid Services, said the agency has limited power to make telehealth-related changes.
"We have regulatory authority over the services that can be done with telehealth and any other payment policy restrictions, like frequency limitations," Yoder explained.
From an executive branch standpoint, Yoder predicted that she doesn't see telehealth becoming less of a priority under new CMS Administrator Chiquita Brooks-LaSure's leadership.
But the major potential limiting factors – such as the types of providers who can furnish telehealth, or originating site requirements – are statutory.
Thus, she said, it's up to Congress to address those statutes, as they temporarily did at the start of the pandemic.
Panelist Mark Hayes, senior vice president of federal policy and advocacy at Ascension, noted that the pandemic made clear that existing restrictions on telehealth are "outdated."
"All of that was written way before even the iPhone came on the market," argued Hayes. "They just haven't kept up with technology."
The uncertainty about when the public health emergency will lift creates "a lot of anxiety," said Hayes.
"When that public health emergency lifts, the [HHS] Secretary's ability to continue these flexibilities evaporates immediately," he warned.
"What we need is for Congress to act before that point hits," he said.
At the same time, it's clear, he said, that legislators want to understand the value proposition of telehealth services: "We need to be able to provide the data to answer those questions."
He predicted that in the shorter term, elected officials will extend the flexibilities rather than enact new policies.
Hayes said that expanded access to telehealth has allowed Ascension to serve its patients better – particularly those who have historically encountered barriers to in-person care.
"It's having a big impact on health equity," he said.