It took a public health emergency to temporarily lift the regulatory barriers that have stifled the growth of telehealth in this country. Now, Congress must act and take the next step, which is to legislate telehealth into the mainstream of medicine and into the outstretched arms of millions of Americans who desperately need it, COVID-19 pandemic or not.
At least 30 U.S. senators from both sides of the aisle are on board: Last week, they wrote to Senate leadership calling on Congress to “expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic. Doing so would assure patients that their care will not be interrupted when the pandemic ends. It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.”
This has been a long time in the making. For the past century, telehealth has been a neglected stepchild of medical practice – its adoption blocked by cumbersome federal regulations, low reimbursement rates and resistance to change. According to a Government Accountability Office report, only 0.2 percent of Medicare Part B beneficiaries were utilizing telemedicine, with the majority of visits (62 percent) for beneficiaries younger than 65 years old.
That was then. This is now.
When the COVID-19 pandemic led to the sudden shut down of much of the country in March, something remarkable happened. The Coronavirus Preparedness and Response Supplemental Appropriations Act was passed and the Centers for Medicare and Medicaid Services was able to sweep away decades of excessive telehealth regulation overnight, providing a new lifeline to seniors and other high-risk individuals who couldn’t seek care in doctor’s offices or clinics amid COVID-19.
The speed of telehealth’s great awakening, and its impact on health care delivery to seniors, have been stunning. In the six weeks following deregulation, the number of Medicare beneficiaries receiving telehealth services surged from 11,000 in the week ending March 7 to 1.3 million in the week ending April 18th — an increase of more than 11,718 percent.
At a time when the Centers for Disease Control and Prevention and the Food and Drug Administration often appeared to be caught flat-footed in responding to the new dangers of COVID-19, decisive leadership from the U.S. Department of Health and Human Services and CMS provided a rare beacon of hope that our federal government could be nimble and flexible when necessary to improve public health.
CMS and HHS did a lot of things right when they deregulated telehealth. In addition to lifting geographic restrictions and allowing seniors living anywhere in the country to have access, the agencies also waived complex HIPAA regulations that forbid physicians from using the most commonly available virtual platforms, such as Facetime and Skype. CMS also permitted doctors to treat over the phone, enabling access for older patients without high-speed internet.
But perhaps the most significant reform was reimbursing physicians for telehealth treatments at the same rate as office visits. Since health care in America is driven largely by market forces, it was unrealistic to expect physicians to adopt telemedicine until incentives were aligned.
However, these much-needed regulatory reforms would never have been possible if telehealth didn’t improve health outcomes, increase patient satisfaction and lower overall costs compared to traditional office visits. Finally, reform is catching up to best practice.
Given the ongoing vulnerability and increasing isolation among frail seniors, as well as the rapid rise of the aging population in the United States over the coming decade, telehealth isn’t just the next best thing to being there. It’s a national imperative whose time has come – just ask at least 30 U.S. senators and millions of Americans.
Shelley Lyford is president and CEO of nonprofit and nonpartisan West Health, Gary and Mary West Foundation, and West Health Institute; she’s also the vice chair of Civica Rx, a unique nonprofit generic drug company, and serves on the California Commission on Aging and California’s Master Plan for Aging Stakeholder Advisory Committee.
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