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Permanent Telehealth Expansion Gains Bipartisan Support

Original article written by Crystal Phend for MedPage Today

Making the pandemic's emergency suspension of Medicare's telehealth rules permanent got overwhelming support at a virtual hearing of the House Committee on Energy and Commerce's health subcommittee back in March. "It's time to make Medicare reimbursement for telehealth permanent," said subcommittee chairwoman Anna G. Eshoo (D-Calif.) in opening the hearing. "Telehealth isn't the silver bullet for the deeper problems that exist in our healthcare system, but it's demonstrated great promise for high quality, innovative care if we intentionally create legislation that fits our nation's needs." CMS temporarily waived geographic and site-related restrictions allowing broad use of video and audio-only telemedicine and has continued to renew those waivers each time the public health emergency has been extended.

Brett Guthrie (R-Ky.) argued for "guardrails" against fraud and abuse of the technology and noted that broadband is a key limiting factor. Jack Resneck Jr., MD, of the American Medical Association Board of Trustees, agreed with many of the representatives who weighed in that broadband isn't just a problem in rural areas, but also for those in urban areas who cannot afford it. Cost was another concern raised by the ranking member of the full House committee, said Cathy McMorris Rodgers (R-Wash.), who is also a leader in the rural health caucus. While Rodgers acknowledged that "telehealth can and should be part of modernizing healthcare in America," she pointed out that Medicare's Hospital Insurance Trust Fund is projected to go bankrupt even at the current pace by 2024.

The perception of overuse leading to increased healthcare costs hasn't been borne out in California's Stanford Health Care system, said its chief of staff, Megan R. Mahoney, MD, who was one of the witnesses called to testify at the hearing. "Telehealth is a tool in our tool kit that is largely substitutive, not additive to in-person care. Practically speaking, we find that the physician's time is still the rate limiting factor for visits per day," she said. Mahoney argued that virtual visits take the same effort and medical decision making, so they should be reimbursed the same as in-person visits.

A number of plans for how to extend the waivers have been introduced, including the TREAT (Temporary Reciprocity to Ensure Access to Treatment) Act and Equal Access to Care Act, which would both be effective until 6 months after the public health emergency ends. The Protecting Access to Post-COVID-19 Telehealth Act introduced by a bipartisan group in the House would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and continue reimbursement for it for 90 days after the end of the pandemic, and would permanently allow HHS to expand telehealth in any disaster situation. The Telehealth Modernization Act would permanently remove Medicare's geographic and originating site restrictions and pull in more types of providers to deliver telehealth, including physical therapists and other allied health professionals. "If we can get this done and done well, we will have made an extraordinary contribution for the American people," Eshoo concluded.

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