In telehealth hearing, House committee weighs access against cost
Members of the U.S. House Committee on Energy and Commerce convened Tuesday to discuss the future of virtual care.
Policymakers and stakeholders emphasized the importance of balancing access to care with addressing concerns around fraud and overutilization.
"Modernizing telehealth policy to meet the moment" is one of lawmakers' most important responsibilities, said Rep. Doris Matsui, D-Calif.
"I've said before the genie is out of the bottle concerning flexibilities and expansion, and I believe this," said Rep. Brett Guthrie, R-Ky.
At the same time, Guthrie pointed out, broadband access continues to be a limiting factor – both in rural and urban environments.
"We need to ensure quality of care is still given by the provider, no matter the setting," said Guthrie.
The hearing came on the heels of the reintroduction of the bipartisan Telehealth Modernization Act in both the House and the Senate, which would safeguard access to coverage after the COVID-19 pandemic.
Witnesses offered a variety of strategies for effectively addressing the future of telehealth.
Some, such as Stanford Health Care Chief of Staff Dr. Megan Mahoney, noted that the transition to telehealth amidst the novel coronavirus pandemic enabled more than 225,000 of the system's patients to complete their first video visit.
In many ways, said Mahoney, telehealth has strengths of its own as a modality.
For example, she said, "I have found a thorough medication review can be more easily and accurately done at home," with pill bottles close at hand.
She stressed the importance of addressing the originating and geographic site requirements outlined in Section 1834(m) of the Social Security Act, which many members of Congress have signaled their support for eliminating.
Mahoney said the restrictions inadvertently create a "donut hole" for Medicare Fee for Service patients, allowing the health system to offer care to everyone but them. She urged policymakers to recognize that video visits and in-person visits require the same effort and medical decision-making by providers, and thus should be reimbursed equally.
"Telehealth is a tool in our toolkit that is largely substitutive, not additive, to in-person care," she said.
Harvard Medical School Associate Professor of Health Policy and Medicine Dr. Ateev Mehrota proposed a more measured approach.
Although the need for telehealth is unmistakable, said Mehrota, policies should encourage "higher-value" applications for care and discourage "lower-value" ones.
He recommended an increase in the use of alternative payment models, especially for primary care providers, physician licensure reciprocity across state lines, coverage of all forms of telemedicine for high-risk patient populations where access is likely difficult and cover virtual care for the rest of the population "only where there is evidence of value or there is compelling need." He also advocated against payment parity for telemedicine and against long-term coverage for audio-only visits.
"While I recognize telephone calls may increase access for disadvantaged populations, I am concerned about a future with a two-tiered system where the poor and disadvantaged have phone calls and the wealthy have video visits," said Mehrota.
When it comes to fraud increase – a frequently invoked fear in conversations around telehealth – some experts said the concern was overblown.
"The AMA believes these concerns are misplaced given CMS’ existing tools for combating fraud and abuse, the increased ability telehealth services provide for documentation and tracking, and the lack of data to suggest that fraud and abuse or duplication are of particular concern for telehealth services," said Dr. Jack Resneck, a member of the American Medical Association Board of Trustees, in prepared testimony.
Resneck pointed out that although bad actors may use telehealth to shield fraud, they are often not fraudulently billing for telehealth.
"Denying patients access to telehealth as a result of these few fraudsters doesn't solve the fraud problems and doesn't help the patients," said Resneck.
Rep. Michael Burgess, R-Texas, raised an interesting challenge: how to ensure telehealth provision itself doesn't become overly burdensome.
Citing a recent study suggesting experts underestimated EHRs' impact on burnout after the HITECH Act, Burgess wondered how to pass policies around virtual care and data sharing that don't make the situation worse. Purchaser Business Group on Health president and CEO Elizabeth Mitchell argued that information siloing would actually make things harder for clinicians.
"We've got to ensure data is meaningfully shared in a way that is easy to use," she said.
Overall, members of Congress remain bullish on virtual care, although the details of payment parity, fraud prevention and coverage specifics continue to arise as hurdles.
"Providers and patients like telehealth, so let's do our best not to mess this up," said Rep. Larry Bucshon, R-Ind.