During the pandemic, Medicare has been paying for health care delivered virtually for a broader swath of patients.
Many view that as a positive development for the future of health care in the United States — but the waivers for telehealth are headed for expiration at the end of the year.
Yet there’s a strong bipartisan push in Congress to make the shift toward telehealth permanent.
Sen. Brian Schatz(D-Hawaii) is leading a bipartisan group of more than 50 senators that have introduced a bill to do just that.
The Connect for Health Act would permanently remove geographic restrictions on telehealth, allow patients to do visits from their homes and grant the Health and Human Services secretary the permanent authority to waive telehealth restrictions.
“We now face the expiration of these authorities and a scenario in which we could go back to the Stone Age in terms of reimbursement for telehealth,” Schatz said.
The bill is strongly bipartisan. Of the 57 co-sponsors on the bill, about half are Democrat and half are Republican.
“Especially on health care, Democrats and Republicans have not seen eye-to-eye on anything at all for more than a decade. The single shining exception to that is telehealth,” Schatz said.
Rep. Mike Thompson (D-Calif) and other leaders in the House telehealth caucus are pushing for a similar legislation in the House.
Other lawmakers want to take a more cautious approach. Rep. Lloyd Doggett (D-Tex.), chairman of the Ways and Means health subcommittee, has said that he intends to introduce legislation that would lift regulatory restrictions on telehealth, but only on a temporary basis.
Doggett told The Health 202 that his bill to extend telehealth waivers through 2022 would give experts and regulators an opportunity to gather more data on telehealth and fashion a far-reaching proposal with more evidence. Doggett points out that the Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare issues, has recommended a limited extension.
“[O]ur understanding of the impact of telehealth is largely limited to data and experience covering only a few months during a once-in-a-century pandemic,” Doggett said.
However it happens, telehealth could be here to stay.
Americans have gotten used to talking to their doctors over phone or video chat over the past year. But Congress would need to act quickly to preserve the new normal. The regulatory changes that made expanded telehealth possible last only through the public health emergency. The Biden administration has said it anticipates the emergency will last through the end of 2021.
Before the pandemic, Medicare generally only reimbursed telehealth visits for rural patients, who were required to go to a health-care setting to make the telehealth call.
The pandemic changed all that. In an effort to support social distancing and keep people from making unnecessary trips to doctors’ offices, the HHS secretary waived many of the restrictions on Medicare reimbursement for telehealth, making it possible for people in urban areas to use it and for patients to call from their homes.
The result: Americans got hooked on telehealth.
Nearly two-thirds of Medicare beneficiaries reported last fall that their provider offers telehealth appointments, up from 18 percent before the pandemic, according to a Kaiser Family Foundation poll.
The pandemic supercharged acceptance of telehealth among doctors and patients, according to Ateev Mehrotra, a hospital-medicine physician who researches telehealth at Harvard Medical School.
“A change that would have occurred over a decade happened in the course of weeks, in terms of providers having these telemedicine visits and patients willing to do it,” Mehrotra said.
The devil is in the details.
Lawmakers and regulators will need to determine what counts as a telehealth visit. Although Medicare has traditionally required video visits, during the pandemic, patients were allowed to connect over the phone.
The decision of whether to allow phone calls as telehealth visits could have a major impact on access for those who have poor Internet connections.
“Some beneficiaries are simply not going to be able to connect or participate in a telehealth service if they have to do it through a video-connected device,” said Juliette Cubanski, deputy director for Medicare policy at the Kaiser Family Foundation.
One thing that isn’t in the leading bill proposals: Paying doctors the same for telemedicine visits as in-person visits.
During the public health emergency, doctors have been able to bill the same amount for telehealth visits as they do for in-person visits.
But many experts say that doesn’t make sense long-term, given that providers can save on overhead when they use telehealth.
Even if telehealth services are billed at a lower rate, lawmakers are still concerned about costs.
Supporters of telehealth laud its ability to reduce barriers to access, but fewer barriers to access can also mean that people use more health care, and that could come with increased costs.
“The very strength of telemedicine is its ability to increase convenience and access to care, and it can also be viewed as its Achilles’ heel. In some circumstances, it can be too easy to get care,” Mehrotra said. “If you make things more convenient, people will use them more.”
The Congressional Budget Office hasn’t scored the Connect for Health Act yet, but it has historically judged increased telehealth to spell higher costs.
Yet Schatz, and other supporters, argue that high-cost estimates for telehealth are missing the savings that come from improving preventive care and shaving off overhead.
“You’re going to increase access, which means that theoretically you could increase the frequency with which people access care,” said Schatz. “That strikes me as a good thing.”
Ahh, oof and ouchAHH: Novavax’s vaccine is 90 percent effective.
“Novavax, a Maryland biotechnology company that endured delays in developing a coronavirus vaccine, revealed results Monday showing that the world is close to having another shot that prevents illness and death, stops virus variants — and proves easy to store,” The Post’s Carolyn Y. Johnson reports.
A 30,000 person trial found that the shot was 90 percent effective in preventing people from falling ill with the coronavirus. The trial, which took place in the United States and Mexico, was conducted when variants were already spreading. There were no cases of severe illness in people who received the vaccine, and side effects appeared to be less frequent than those triggered by some already authorized vaccines.
“The good news comes with a caveat: The vaccine may not begin to have a large impact on the pandemic until late summer or fall,” Carolyn writes.
Novavax has said that the company will file for regulatory approval in half a dozen countries in the third quarter, which begins in July. The company has tens of millions of doses in inventory and plans to scale up production to 100 million doses a month in September and 150 million a month by the last three months of the year.
OOF: Drug pricing critics have remained relatively silent about the pricey new Alzheimer’s drug.
“The FDA’s approval of an expensive new Alzheimer’s therapy would seem like the perfect candidate for inflaming Washington’s long-running debate over sky-high prescription drug prices,” Politico’s Susannah Luthi and Rachel Roubein report.
There is little evidence that the new therapy, aducanumab, is effective, and its hefty $56,000 annual price tag is likely to drive up insurance premiums and could cost Medicare billions. The FDA’s controversial decision to approve the drug prompted the resignation of three outside advisers to the agency.
“But hardly anybody on Capitol Hill is talking about it, worried they’ll be seen as dashing desperate patients’ hope for an Alzheimer’s treatment — even one that may provide little or no benefit,” Susannah and Rachel write.
Senate Finance Committee Chair Ron Wyden (D-Ore.) and Rep. Peter Welch (D-Vt.), both outspoken on drug pricing issues, have criticized the drug’s price tag. But many other Democrats have steered clear of the issue.
The controversy over the Alzheimer’s treatment is playing out in the absence of a permanent FDA chief. Janet Woodcock, the agency’s acting commissioner, appeared to distance herself from the decision to approve aducanumab. She did not release a statement or appear with other agency officials in a briefing after the approval. Still, it’s not clear whether this will hurt her standing with the administration. Politico reported last week that she remains President Biden’s favorite for the role.
OUCH: At least 60 million doses of Johnson & Johnson’s vaccine must be discarded.
The Food and Drug Administration has decided the doses, which were made at the troubled Emergent BioSolutions plant, must be discarded over safety concerns. The agency extensively reviewed and released another 10 million doses, which are expected to go overseas as part of Biden’s effort to share vaccines globally. Millions of other doses made at the plant are still under review, The Post’s Laurie McGinley, Christopher Rowland and Isaac Stanley-Becker report.
The 60 million doses that must be discarded are in addition to the 15 million already thrown out that were contaminated by the AstraZeneca vaccine at the plant earlier this year, a person who spoke on the condition of anonymity told The Post.
Johnson & Johnson was banking on the Emergent plant for U.S. supply of its vaccine, but so far no doses from the plant have been distributed. The doses of Johnson & Johnson vaccine that were distributed came from the company’s operations in the Netherlands. But the supply dried up in the United States. In May, the Biden administration stopped making new doses available to states.
That could soon change. One official told The Post that the expectation is that new Johnson & Johnson doses will be available to the states by next week.
In the courtsA judge dismissed a lawsuit filed by hospital employees who refused a coronavirus vaccine.
U.S. District Judge Lynn N. Hughes dismissed a lawsuit filed by 117 staffers at Houston Methodist over the hospital’s coronavirus vaccine requirement for employees.
“The lawsuit’s dismissal appears to be one of the first rulings over an issue that has sparked contentious debate across the country as the economy opens up and more people return to school and work. Legal experts expect further litigation as some businesses, hospitals and universities begin requiring vaccination,” The Post’s Brittany Shammas and Paulina Firozi report.
Hughes rejected the lawsuit’s claim that the vaccines are experimental and took particular issue with the complaint equating the mandate to medical experimentation during the Holocaust, calling the comparison “reprehensible.”
“Methodist is trying to do their business of saving lives without giving them the covid-19 virus,” Hughes wrote. “It is a choice made to keep staff, patients and their families safer.”
More in coronavirus newsNearly 600,000 Americans have died of covid-19.
“The Americans who have died of covid-19 in recent days and weeks — the people whose deaths have pushed the total U.S. loss from the pandemic to nearly 600,000 — passed away even as their families, friends and neighbors emerged from 15 months of isolation and fear. The juxtaposition is cruel: Here, masks off; workplaces, shops and schools reopening. There, people struggling to breathe, separated from loved ones, silenced by ventilators,” The Post’s Marc Fisher, Fenit Nirappil, Annie Gowen and Lori Rozsa report.
“It has taken about as long to move from 500,000 U.S. deaths to 600,000 as it did to go from zero to the first dark marker of 100,000 — about four months. That’s a huge improvement over the harrowing one month it took for the death count to soar from 300,000 to 400,000 last winter,” our colleagues write.
But that’s little solace to those who lost loved ones. “The finish line is in sight and if you don’t make it now, it’s like the astronauts who make it all the way home and then their capsule splashes down and sinks,” Peter Paganussi, an emergency room physician in Ranson, W.Va., told The Post.
Fully vaccinated commercial fishermen may ditch the masks.
The Coast Guard and CDC have updated guidance to say fishermen no longer must wear masks while outside on commercial fishing vessels.
As we reported last month, fishermen – who often work in small crews of five people or fewer – had to wear masks even though they often rely on signs and facial expressions to communicate with each other on the decks of their vessels.
Group of Seven leaders called for a new investigation into the coronavirus origins and promised 1 billion vaccine doses for poorer countries, The Post’s Karla Adam, Ashley Parker, Tyler Pager and John Hudson report.
Most Americans support requiring adolescents to receive a coronavirus vaccines for school attendance, according to a Gallup poll.
A man received a 10-year sentence for attacking and coughing on a man who asked him to pull up his mask, The Post’s Timothy Bella reports.
Elsewhere in health careThe elderly are taking more drugs that can increase the risk of falls.
A new study from researchers at the University of Buffalo found a dramatic increase in the number of Americans over 65 who are taking drugs that raise the risk of dangerous falls.
“In 2017, an estimated 94 percent of older adults received a prescription for a drug that increased their risk of falling, a startling increase from 57 percent in 1999, according to the research. The study also found that the rate of death caused by falls in older adults more than doubled during the same time period,” Marlene Cimons writes for The Post.
Many of the drugs play an important function, for instance lowering blood pressure, improving mood, preventing seizures or fighting allergies, but the researchers called for more attention to potentially problematic side effects. Falls are the leading cause of fatal and nonfatal injuries in people over 65.
Lawmakers Are Deciding the Future of Telehealth
Washington Post
June 14, 2021 1:41 pm
During the pandemic, Medicare has been paying for health care delivered virtually for a broader swath of patients.
Many view that as a positive development for the future of health care in the United States — but the waivers for telehealth are headed for expiration at the end of the year.
Yet there’s a strong bipartisan push in Congress to make the shift toward telehealth permanent.
Sen. Brian Schatz(D-Hawaii) is leading a bipartisan group of more than 50 senators that have introduced a bill to do just that.
The Connect for Health Act would permanently remove geographic restrictions on telehealth, allow patients to do visits from their homes and grant the Health and Human Services secretary the permanent authority to waive telehealth restrictions.
“We now face the expiration of these authorities and a scenario in which we could go back to the Stone Age in terms of reimbursement for telehealth,” Schatz said.
The bill is strongly bipartisan. Of the 57 co-sponsors on the bill, about half are Democrat and half are Republican.
“Especially on health care, Democrats and Republicans have not seen eye-to-eye on anything at all for more than a decade. The single shining exception to that is telehealth,” Schatz said.
Rep. Mike Thompson (D-Calif) and other leaders in the House telehealth caucus are pushing for a similar legislation in the House.
Other lawmakers want to take a more cautious approach. Rep. Lloyd Doggett (D-Tex.), chairman of the Ways and Means health subcommittee, has said that he intends to introduce legislation that would lift regulatory restrictions on telehealth, but only on a temporary basis.
Doggett told The Health 202 that his bill to extend telehealth waivers through 2022 would give experts and regulators an opportunity to gather more data on telehealth and fashion a far-reaching proposal with more evidence. Doggett points out that the Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare issues, has recommended a limited extension.
“[O]ur understanding of the impact of telehealth is largely limited to data and experience covering only a few months during a once-in-a-century pandemic,” Doggett said.
However it happens, telehealth could be here to stay.
Americans have gotten used to talking to their doctors over phone or video chat over the past year. But Congress would need to act quickly to preserve the new normal. The regulatory changes that made expanded telehealth possible last only through the public health emergency. The Biden administration has said it anticipates the emergency will last through the end of 2021.
Before the pandemic, Medicare generally only reimbursed telehealth visits for rural patients, who were required to go to a health-care setting to make the telehealth call.
The pandemic changed all that. In an effort to support social distancing and keep people from making unnecessary trips to doctors’ offices, the HHS secretary waived many of the restrictions on Medicare reimbursement for telehealth, making it possible for people in urban areas to use it and for patients to call from their homes.
The result: Americans got hooked on telehealth.
Nearly two-thirds of Medicare beneficiaries reported last fall that their provider offers telehealth appointments, up from 18 percent before the pandemic, according to a Kaiser Family Foundation poll.
The pandemic supercharged acceptance of telehealth among doctors and patients, according to Ateev Mehrotra, a hospital-medicine physician who researches telehealth at Harvard Medical School.
“A change that would have occurred over a decade happened in the course of weeks, in terms of providers having these telemedicine visits and patients willing to do it,” Mehrotra said.
The devil is in the details.
Lawmakers and regulators will need to determine what counts as a telehealth visit. Although Medicare has traditionally required video visits, during the pandemic, patients were allowed to connect over the phone.
The decision of whether to allow phone calls as telehealth visits could have a major impact on access for those who have poor Internet connections.
“Some beneficiaries are simply not going to be able to connect or participate in a telehealth service if they have to do it through a video-connected device,” said Juliette Cubanski, deputy director for Medicare policy at the Kaiser Family Foundation.
One thing that isn’t in the leading bill proposals: Paying doctors the same for telemedicine visits as in-person visits.
During the public health emergency, doctors have been able to bill the same amount for telehealth visits as they do for in-person visits.
But many experts say that doesn’t make sense long-term, given that providers can save on overhead when they use telehealth.
Even if telehealth services are billed at a lower rate, lawmakers are still concerned about costs.
Supporters of telehealth laud its ability to reduce barriers to access, but fewer barriers to access can also mean that people use more health care, and that could come with increased costs.
“The very strength of telemedicine is its ability to increase convenience and access to care, and it can also be viewed as its Achilles’ heel. In some circumstances, it can be too easy to get care,” Mehrotra said. “If you make things more convenient, people will use them more.”
The Congressional Budget Office hasn’t scored the Connect for Health Act yet, but it has historically judged increased telehealth to spell higher costs.
Yet Schatz, and other supporters, argue that high-cost estimates for telehealth are missing the savings that come from improving preventive care and shaving off overhead.
“You’re going to increase access, which means that theoretically you could increase the frequency with which people access care,” said Schatz. “That strikes me as a good thing.”
Ahh, oof and ouchAHH: Novavax’s vaccine is 90 percent effective.
“Novavax, a Maryland biotechnology company that endured delays in developing a coronavirus vaccine, revealed results Monday showing that the world is close to having another shot that prevents illness and death, stops virus variants — and proves easy to store,” The Post’s Carolyn Y. Johnson reports.
A 30,000 person trial found that the shot was 90 percent effective in preventing people from falling ill with the coronavirus. The trial, which took place in the United States and Mexico, was conducted when variants were already spreading. There were no cases of severe illness in people who received the vaccine, and side effects appeared to be less frequent than those triggered by some already authorized vaccines.
“The good news comes with a caveat: The vaccine may not begin to have a large impact on the pandemic until late summer or fall,” Carolyn writes.
Novavax has said that the company will file for regulatory approval in half a dozen countries in the third quarter, which begins in July. The company has tens of millions of doses in inventory and plans to scale up production to 100 million doses a month in September and 150 million a month by the last three months of the year.
OOF: Drug pricing critics have remained relatively silent about the pricey new Alzheimer’s drug.
“The FDA’s approval of an expensive new Alzheimer’s therapy would seem like the perfect candidate for inflaming Washington’s long-running debate over sky-high prescription drug prices,” Politico’s Susannah Luthi and Rachel Roubein report.
There is little evidence that the new therapy, aducanumab, is effective, and its hefty $56,000 annual price tag is likely to drive up insurance premiums and could cost Medicare billions. The FDA’s controversial decision to approve the drug prompted the resignation of three outside advisers to the agency.
“But hardly anybody on Capitol Hill is talking about it, worried they’ll be seen as dashing desperate patients’ hope for an Alzheimer’s treatment — even one that may provide little or no benefit,” Susannah and Rachel write.
Senate Finance Committee Chair Ron Wyden (D-Ore.) and Rep. Peter Welch (D-Vt.), both outspoken on drug pricing issues, have criticized the drug’s price tag. But many other Democrats have steered clear of the issue.
The controversy over the Alzheimer’s treatment is playing out in the absence of a permanent FDA chief. Janet Woodcock, the agency’s acting commissioner, appeared to distance herself from the decision to approve aducanumab. She did not release a statement or appear with other agency officials in a briefing after the approval. Still, it’s not clear whether this will hurt her standing with the administration. Politico reported last week that she remains President Biden’s favorite for the role.
OUCH: At least 60 million doses of Johnson & Johnson’s vaccine must be discarded.
The Food and Drug Administration has decided the doses, which were made at the troubled Emergent BioSolutions plant, must be discarded over safety concerns. The agency extensively reviewed and released another 10 million doses, which are expected to go overseas as part of Biden’s effort to share vaccines globally. Millions of other doses made at the plant are still under review, The Post’s Laurie McGinley, Christopher Rowland and Isaac Stanley-Becker report.
The 60 million doses that must be discarded are in addition to the 15 million already thrown out that were contaminated by the AstraZeneca vaccine at the plant earlier this year, a person who spoke on the condition of anonymity told The Post.
Johnson & Johnson was banking on the Emergent plant for U.S. supply of its vaccine, but so far no doses from the plant have been distributed. The doses of Johnson & Johnson vaccine that were distributed came from the company’s operations in the Netherlands. But the supply dried up in the United States. In May, the Biden administration stopped making new doses available to states.
That could soon change. One official told The Post that the expectation is that new Johnson & Johnson doses will be available to the states by next week.
In the courtsA judge dismissed a lawsuit filed by hospital employees who refused a coronavirus vaccine.
U.S. District Judge Lynn N. Hughes dismissed a lawsuit filed by 117 staffers at Houston Methodist over the hospital’s coronavirus vaccine requirement for employees.
“The lawsuit’s dismissal appears to be one of the first rulings over an issue that has sparked contentious debate across the country as the economy opens up and more people return to school and work. Legal experts expect further litigation as some businesses, hospitals and universities begin requiring vaccination,” The Post’s Brittany Shammas and Paulina Firozi report.
Hughes rejected the lawsuit’s claim that the vaccines are experimental and took particular issue with the complaint equating the mandate to medical experimentation during the Holocaust, calling the comparison “reprehensible.”
“Methodist is trying to do their business of saving lives without giving them the covid-19 virus,” Hughes wrote. “It is a choice made to keep staff, patients and their families safer.”
More in coronavirus newsNearly 600,000 Americans have died of covid-19.
“The Americans who have died of covid-19 in recent days and weeks — the people whose deaths have pushed the total U.S. loss from the pandemic to nearly 600,000 — passed away even as their families, friends and neighbors emerged from 15 months of isolation and fear. The juxtaposition is cruel: Here, masks off; workplaces, shops and schools reopening. There, people struggling to breathe, separated from loved ones, silenced by ventilators,” The Post’s Marc Fisher, Fenit Nirappil, Annie Gowen and Lori Rozsa report.
“It has taken about as long to move from 500,000 U.S. deaths to 600,000 as it did to go from zero to the first dark marker of 100,000 — about four months. That’s a huge improvement over the harrowing one month it took for the death count to soar from 300,000 to 400,000 last winter,” our colleagues write.
But that’s little solace to those who lost loved ones. “The finish line is in sight and if you don’t make it now, it’s like the astronauts who make it all the way home and then their capsule splashes down and sinks,” Peter Paganussi, an emergency room physician in Ranson, W.Va., told The Post.
Fully vaccinated commercial fishermen may ditch the masks.
The Coast Guard and CDC have updated guidance to say fishermen no longer must wear masks while outside on commercial fishing vessels.
As we reported last month, fishermen – who often work in small crews of five people or fewer – had to wear masks even though they often rely on signs and facial expressions to communicate with each other on the decks of their vessels.
Group of Seven leaders called for a new investigation into the coronavirus origins and promised 1 billion vaccine doses for poorer countries, The Post’s Karla Adam, Ashley Parker, Tyler Pager and John Hudson report.
Most Americans support requiring adolescents to receive a coronavirus vaccines for school attendance, according to a Gallup poll.
A man received a 10-year sentence for attacking and coughing on a man who asked him to pull up his mask, The Post’s Timothy Bella reports.
Elsewhere in health careThe elderly are taking more drugs that can increase the risk of falls.
A new study from researchers at the University of Buffalo found a dramatic increase in the number of Americans over 65 who are taking drugs that raise the risk of dangerous falls.
“In 2017, an estimated 94 percent of older adults received a prescription for a drug that increased their risk of falling, a startling increase from 57 percent in 1999, according to the research. The study also found that the rate of death caused by falls in older adults more than doubled during the same time period,” Marlene Cimons writes for The Post.
Many of the drugs play an important function, for instance lowering blood pressure, improving mood, preventing seizures or fighting allergies, but the researchers called for more attention to potentially problematic side effects. Falls are the leading cause of fatal and nonfatal injuries in people over 65.