Telehealth’s future hangs in the balance

April 11, 2024 10:48 am

A MATTER OF DOLLARS AND CENTS — Congress appears poised to keep eased Medicare telehealth rules in place with at least another temporary extension, but members are concerned about costs and unintended consequences.

Loosened virtual-care rules for Medicare and commercial markets expire at the end of 2024, and lawmakers are setting the stage for a possible temporary or permanent extension of the regulations to preserve expanded access. The House Ways and Means and Senate Finance committees have met recently to consider expanded telehealth rules.

In a House Energy and Commerce Health Subcommittee hearing Wednesday, Democrats and Republicans indicated support for maintaining expanded telehealth payment for older adults but raised a number of issues:

Cost: The cost to extend the eased rules is a major concern for lawmakers. A key question is whether virtual visits would be reimbursed at the same rate as in-person care.

“Making these authorities permanent is likely to cost much more than a short-term extension, and we want to make sure that whatever we move out of committee is paid for,” Health Subcommittee Chair Brett Guthrie (R-Ky.) said.

But, generally, lawmakers seemed willing to accept higher costs to expand access to virtual care. Full committee ranking member Cathy McMorris Rodgers (R-Wash.) acknowledged that extending the rules would be a “significant investment” but said that “we can’t afford to go backwards.”

Harvard researcher Ateev Mehrotra told lawmakers that expanded telehealth is associated with a “modest” increase in spending but also improved outcomes, particularly in mental health.

Trickle-down impact: Lawmakers want to ensure that changes to virtual care policy don’t hinder access to in-person care.

Rodgers said she wants to ensure patients decide whether they get in-person or virtual care. Witnesses and lawmakers noted that some patients may prefer in-person care.

Full committee ranking member Frank Pallone (D-N.J.) said he doesn’t want telehealth to be used to undermine consumer protections like network adequacy standards.

“We also need to ensure that we are not further fragmenting care and that telehealth is being used in a way that facilitates coordination,” Pallone said.

Industry ‘gaming’: Health Subcommittee ranking member Anna Eshoo (D-Calif.) raised concerns about the industry “gaming” virtual care to make it into a “cash cow.”

What’s next: The Medicare Payment Advisory Commission meets today on telehealth in Medicare.