340 Healthcare Organizations Urge Congress to Make Telehealth Flexibilities Permanent

Three hundred and forty organizations have signed a letter urging Congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. Those signing this multi-stakeholder letter include national and regional organizations representing a full range of healthcare stakeholders and all 50 states, the District of Columbia, and Puerto Rico.

As COVID-19 cases quickly began to ramp up earlier this year, Congress swiftly waived statutory barriers to allow for expanded access to telehealth at the beginning of the COVID-19 pandemic, providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually. In March and April, federal health officials moved quickly to specifically remove payment- and licensing-related barriers to the expansion of telehealth. However, the groups wrote this week, “If Congress does not act before the COVID-19 public health emergency expires, current flexibilities will immediately disappear.”

The letter emphasized the importance of providing telehealth services during the pandemic—care that would not have been able to be delivered without the loosening of prior restrictions. The organizations wrote, “Providers across the country have utilized these flexibilities to scale delivery and provide older Americans, many for the first time, access to high quality virtual care, resulting in 11.3 million beneficiaries accessing telehealth services in mid-April alone. Medicare Advantage plans have driven a similar expansion with 91 percent of seniors reporting a favorable telehealth experience and 78 percent likely to use telehealth again in the future, figures that closely track with similar patient satisfaction data from health systems nationwide. Additional flexibility has also allowed Federally Qualified Health Centers (FQHC) to deliver safe and effective care to underserved patient populations that have rated the service they received highly.”

Private health plans have also followed suit, the groups noted, and in response, telehealth adoption has skyrocketed, resulting in a 4,300 percent year-over-year increase in claims for March 2020. The letter went on to say, “Taken as a whole, these temporary policy changes have allowed 46 percent of Americans to replace a cancelled healthcare visit with a telehealth service during the pandemic. With so many patients accessing care virtually, expectations for the future of our healthcare system have shifted significantly and 76 percent of Americans now report having a strong interest in using telehealth moving forward.”

Over the past several weeks, Healthcare Innovation has highlighted the telehealth progress experienced in various health systems in the face of COVID-19, with MedStar Health, Stanford Children’s Health, and Augusta University Health representing just a few examples. Executive leaders at the College of Healthcare Information Management Executives (CHIME) recently stated that “Telehealth has been a resounding success as healthcare organizations quickly implemented solutions to remotely care for patients during the COVID-19 pandemic…”

Much of this telehealth transformation, however, according to the writing organizations, “is dependent on temporary flexibilities extended to health systems and providers that are limited to the duration of the COVID-19 public health emergency declaration. Absent additional action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth services when the emergency declaration ends,” they contended.

They noted that statutory restrictions within the Social Security Act and that the authorities granted to HHS and CMS through recent coronavirus legislation are limited to the COVID-19 public health emergency period, meaning that “Congress must act to ensure that the Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services.”

As such, the groups are asking that Congress advance permanent telehealth reform focused on the following priorities:

• Remove obsolete restrictions on the location of the patient: Congress should permanently remove the current section 1834(m) geographic and originating site restrictions to ensure that all patients can access care at home, and other appropriate locations.

• Maintain and enhance HHS authority to determine appropriate providers and services for telehealth: Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. What’s more, they said that HHS and CMS should maintain the authority to add or remove eligible telehealth services—as supported by data and demonstrated to be safe, effective, and clinically appropriate—through a predictable regulatory process that gives patients and providers transparency and clarity.

• Ensure that FQHCs and Rural Health Clinics (RHCs) can furnish telehealth services after the public health emergency

• Make permanent HHS temporary waiver authority during emergencies: Congress has given HHS authority under Section 1135 of the Social Security Act to waive restrictions during the COVID-19 pandemic, but the waiver authority is specific to this particular emergency. Congress should ensure HHS and CMS can act quickly during future pandemics and natural disasters.

The letter concluded that “Swift congressional action will provide a clear signal to patients, who are concerned about the future of their telehealth benefits, as well as providers and health systems, which are hesitant to make investments in critical healthcare infrastructure without certainty from policymakers. We need your support in ensuring that seniors and providers do not go over the telehealth ‘cliff’– losing access to these critical services when they are still needed by so many.”

The letter was accompanied with a number of statements from executive leaders from the signing organizations. Jennifer Covich Bordenick, CEO, eHealth Initiative, for example, noted, “The pandemic provided us with an opportunity to see the benefits of broad telehealth adoption. Virtual care doesn’t just support COVID-19 care, it increases access to communities and consumers for whom traditional office visits don’t always work. Hundreds of organizations want Congress to make these changes permanent because they make sense clinically and financially for both providers and patients.”

Scott Whitaker, president and CEO of AdvaMed, a medical device trade association, added, “Too many patients are still going without care that is absolutely vital to their health and putting essential medical procedures on hold due to the pandemic or lack of access to care. Making recently expanded telehealth access permanent will improve patients’ ability to get care outside of doctors’ offices and other traditional healthcare settings and save and improve countless lives.”