US Legislators Talk Telehealth Cost, Quality As Cutoff Nears


Lawmakers in the US have gone on to laud the advantages of telehealth in a hearing held on April 10, but House members also went ahead and raised questions pertaining to cost, quality, as well as the access that still have to be answered as a year-end deadline looms.

The fact is that as the December 2024 deadline draws closer, legislators happen to be working to hash out details pertaining to extending or even making pandemic-era telehealth flexibilities within Medicare permanent.

In an hours-long House Energy and Commerce subcommittee hearing, lawmakers went on to consider 15 different legislative proposals that happened to surround telehealth access, noting changes within Medicare will go on to impact decisions pertaining to private insurers.

Rep. Anna Eshoo said there is indeed an urgent requirement so as to extend these flexibilities because they are indeed going to run out and certainly need to take action on this.

It is well to be noted that during a public health emergency, regulators loosened some of the telehealth rules, such as allowing beneficiaries to go ahead and receive virtual care in their homes, eradicating the geographic restrictions, and expanding the audio-only telehealth services.

While there are some changes which have been made permanent, others are due to expire at the end of 2024, which could as well spell a crisis for providers as well as patients who are used to flexibilities, the witnesses at the hearing told the lawmakers.

The fact is that some policy questions that surround telehealth still linger, such as how to make sure of quality care and continuing access to in-person services and how much to pay providers when it comes to telehealth.

As per Rep. Brett Guthrie, the looming deadline goes on to give a chance to assess the long-term telehealth solutions, that can indeed drive innovation within the healthcare gamut by way of greater delivery.

The question now is: how much does Medicare go on to pay for telehealth?

It is worth noting that telehealth does surge healthcare spending modestly, but it is also linked to enhancements in access as well as care quality, said professor of healthcare policy and medicine, Harvard Medical School, Ateev Mehrotra.

However, the providers have to be paid less when it comes to the virtual services, he added. Medicare payments have to be based on the time it takes to go ahead and offer care and the associated space, staff, and equipment, so the fact remains that virtual care should cost less and should be reimbursed at lower levels.

In addition to this, the payment parity with in-person services can also encourage providers to go ahead and give up their physician practices, or even offer an unfair advantage to telehealth companies that only provide virtual care.

Still, the fact remains that providing telehealth does not mean other overhead costs happen to go away, said group vice president as well as the chief of virtual care and digital health, health system Providence, Eve Cunningham, and apparently, it does take resources to set up as well as manage a virtual care program.

Underpaying could go on to create the wrong incentives as well, opines Rep. Larry Bucshon.

He adds that one really cannot pay substantially less when it comes to telehealth services. There has to be a balance in it, because that will, in a way, discourage providers from giving them at all.

Questions pertaining to quality

Lawmakers, notably, also went ahead and raised questions pertaining to what types of care are best suited when it comes to telehealth services.

Rep. Kim Schrier says that as a community pediatrician, what is needed is a height, a weight, and a growth chart. There is a need for blood pressures too, as well as that pre-work before one walk into the office. What Kim goes on to evaluate is how many diagnoses have actually got missed since one did not see curve in the back, a mole on the skin, or falling off when it comes to a growth curve?

Apparently, when the patients returned to physician’s offices after the pandemic eased, providers may have gauged new symptoms after getting a physical exam done, said the senior vice president and chief digital health officer with Yale New Haven Health System, Lee Schwamm. However, many people simply are not able to access care at all, which is indeed an area where telehealth could go ahead and help.

He adds that they might have missed some things, but in comparison to what? Probably in comparison to perfect in-person care, sure. However, in comparison to reality, he thinks they are more likely to pick up signs as well as symptoms because they happen to be actually interacting with the person.

Another quality concern happens to be the care offered by telehealth-only companies, said Mehrotra from Harvard. In a written testimony, he cited one of the startups and a mental healthcare provider, Cerebral, which was accused of going ahead and overprescribing prescription stimulants, thereby arguing on the fact that there was a shortage of data on telehealth-only companies’ effect when it came to quality.

Preserving access to in-person care

Interestingly, Medicare beneficiaries also need to be able to access the in-person options if they go on to prefer, witnesses as well as lawmakers said.

To make sure of an in-person access for beneficiaries, telehealth providers should not be enabled to go ahead and meet network adequacy rules for the Medicare Advantage plans, said President of the nonprofit Medicare Rights Center, Fred Riccardi. Now that there are more than half of the eligible beneficiaries who are enrolled in the private MA plans, telehealth companies should not be able to meet those standards and, at the same time, inadvertently erode in-person access, he said.

As per Rep. Frank Pallone, it is indeed important that one goes on to preserve patient choice and that Medicare beneficiaries continue to have access to high-quality in-person care as well as robust consumer protections, such as network adequacy standards.

The fact is that Congress needs to take that action soon in order to reduce uncertainty for providers, the witnesses said.

Patients go on to anticipate this model of care now, and the providers have to have a permanent solution so as to justify the funds required in order to support telehealth, Cunningham from Providence said.

She remarked that when there is uncertainty in the reimbursement model and they happen to be kicking the can down the road in one year, the next year, there happens to be a hesitancy, specifically from these smaller practices, so as to really go all-in as there is an investment involved in making that kind of transition. The fact is that they need to have that sort of reassurance that reimbursement will be stable.