There is a major caveat to the telehealth expansion that Congress just made


Congress this week passed its 2022 omnibus spending bill, expanding coverage of telehealth services under the Centers for Medicare and Medicaid Services — a major win for telehealth companies and the more than 130 million patients who depend on socialized medicine. But some experts warn that as more telehealth services are covered by insurers, governments may lose interest in healthcare initiatives that give patients the most care for their dollar.

The provision does a number of things. First, it extends coverage for certain telehealth services under Medicare and Medicaid to 151 days after the pandemic-era public health emergency ended in April. Second, it adds audiology, occupational therapy, physical therapy and speech pathology to the list of reimbursed telehealth services. Third, the Medicare Payment Advisory Commission, an independent federal agency that advises Congress on Medicare policy, is tasked with studying the use and impact of telehealth services on patients for the coming year with a view to assessing whether it improves the quality of care decreases.

“It’s a positive sign that Congress is beginning to see the value of telehealth services,” said Nicol Turner Lee, senior researcher and director of the Center for Technology Innovation at the Brookings Institution. “Now we need to move that temporary interest into a more permanent structure.”

In the past two years, a number of legislative efforts have been made to ensure that telehealth services can continue to be reimbursed under Medicare and Medicaid even after the pandemic is officially declared over. Telehealth companies like Teladoc have funneled hundreds of thousands of dollars into lobbying efforts to get telehealth permanently under CMS. In general, strengthening telehealth in public health infrastructure is a two-pronged issue, and politicians on both sides of the aisle seem to support it. Several bills deal with enabling telecare for rural communities, where access to care services is often limited. Turner Lee says future legislation will need to take into account those in rural areas who do not have internet access. “You can’t really use it without broadband,” she says.

But there would be more broadband access. “After we spend that $65 billion, that excuse is gone,” said Virginia Senator Mark Warner, referring to the money earmarked for broadband expansion within the trillion dollar infrastructure package that was passed last year. Warner, a long-time proponent of telehealth, worked on the CONNECT for Health Act 2021, which aims to expand the scope of refundable telehealth services. (The bill was originally introduced in 2019, failed to pass a vote, and was reintroduced in April 2021.) The bill would include telemedicine addiction treatment and the ability to prescribe certain controlled substances, such as suboxone, which is used to treat to treat opioids. addiction, about telecare. It would also put in place surveillance mechanisms to prevent fraud and abuse, which Warner sees as one of the few arguments against telehealth — and not a great one.

“As far as I know, the level of fraud and abuse is quite low,” he says.

Niam Yaraghi, an assistant professor of business technology at Miami Herbert Business School and a senior Brookings fellow, sees another argument against expanding telehealth. “What worries me is that they would expand billable services to telehealth and destroy their entire incentive for value-based care,” he says. In other words, by focusing so much on ongoing patient access to telecare, Congress could inadvertently encourage health care providers to abandon the value-based model of care in favor of a more lucrative pay-per-service approach.

Since the passage of the Affordable Care Act in 2010, CMS has developed programs for Medicare patients that are based on value-based care, that is, a payment model in which the agency pays doctors to keep patients healthy, rather than for individual services. such as an ultrasound, MRI, or an annual exam. Value-based care shows promise for reducing overall health care spending and improving patient health, but studies evaluating value-based care programs have been mixed so far. While there’s some evidence it could curb costs, some health care experts question whether value-based care can actually provide better health care for patients than they already receive. Others think that value-driven care is an integral part of the future of healthcare. Yaraghi says Congress’ push to expand reimbursable services, such as telehealth, could indicate a declining affinity for value-based care.

Senator Warner, for his part, thinks the value-based care model needs work. “I’m a big believer in value-based care, but I’m not sure if I believe the promises have already been met,” he says. He also questions whether reimbursing telecare is necessarily the demise of value-based care.

As for enacting telecare into law, details have yet to be worked out, he says, such as which services will eventually be included and how much telecare services should cost compared to in-person care. However, the main barrier to passage, he says, will be cost. That said, he has seen widespread support for insurance-covered telehealth.

“I can’t imagine that one of the few good things that comes out of COVID should be allowed to expire,” he says.


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