Keep telehealth alive and well, experts tell Senate subcommittee

For many Americans, telehealth options for connecting with their health care providers seemed to suddenly come to life in 2020, even though some virtual care options started years before that.

Now, experts warn, telehealth could face a slow or even quick death if policymakers don’t take concrete action soon.

That’s because the temporary Medicare rules created at the start of the COVID-19 pandemic will expire on December 31, 2024.

Four of those experts, including Michigan Medicine’s Chad Ellimoottil, MD, MS, testified before the Senate Finance Committee’s Subcommittee on Health Care on Nov. 14 about the urgent need for action.

The hearing, held by senators who play a key role in shaping Medicare policy for the nation, is available to watch.

“The slow death of telehealth can occur as patients and providers become increasingly frustrated with regulations and unexpected bills and eventually stop using telehealth,” Elimutil warned in its prepared testimony.

“Making the expansion of telehealth permanent means ensuring that Medicare beneficiaries have a choice in how they receive their care, whether it’s in person, by videotape or by phone call.”

Ellimutil cited research conducted by its Telehealth Research Incubator team and the University of Michigan and beyond on the use of telehealth before and after March 2020.

He is the former director of telehealth research at UM’s Institute for Health Policy and Innovation and medical director of virtual care at UM Medical Group, a group practice at the University of Michigan School of Medicine.

He also spoke of his experience as a urologist dealing with patients considering surgery or symptom management, including patients in rural areas with poor connectivity for video-based appointments.

For them, he told senators, the ability to hold audio-only meetings over the phone and have Medicare pay for the session would be vital.

He said it’s also important to establish permanent Medicare rules that allow telehealth appointments to originate from a patient’s home or other location, rather than just an approved clinical location, as was the case before the pandemic.

Allowing flexibility for geographic location is also vital.

Ellimutil also called for telehealth-based care to be reimbursed at the same rate as in-person care because of the ongoing costs of maintaining clinics and staff. He also warned that regulators should avoid putting up telehealth “gatekeepers” that are not based on clinical evidence as a way to prevent fraud and abuse.

What happens in the next few months with Medicare policy, he and other witnesses told senators, will have ripple effects for people who also have other forms of health insurance. In fact, the uncertainty surrounding telehealth payment after Medicare ends in 2024 has already begun to create problems.

“If Medicare continues to view expanded telehealth coverage as ‘temporary,’ commercial payers will reduce or eliminate their coverage for telehealth services,” he said.

“This is already underway, and we are witnessing the development of a fragmented telehealth payment system that creates confusion for both patients and providers.”