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Virtual care will become a common cause in a divided congress



The new dynamic is being driven by the way Americans were quick to adopt long-distance coverage during the lockdown, which has helped cement an enduring role for a largely niche industry to date. A Senate plan, p. 1512 (117) by Brian Schatz, D-Hawaii, that would permanently anchor many of the Trump Medicare coverage and payment rules, has attracted 59 co-sponsors. Many private insurers have already started offering or expanding virtual visits.

“We got to the point where when I talked to someone about telemedicine, their eyes glazed over,” said Schatz. “Now when I start talking about telemedicine, your head nods up and down vigorously.”

However, skeptics warn that a rapid expansion of telemedicine could trigger a surge in new health spending. The Congressional Budget Office has long resisted plans to increase payments for the technology and warns of the financial burden it could put on payers. Medicare Advisory Committee MedPAC has recommended a cautious approach that would temporarily cover some telehealth services for all beneficiaries, but would revert to lower reimbursement rates for virtual appointments compared to face-to-face appointments after the crisis. There are also concerns that rapid expansion could lead to more fraudulent billing: the HHS Office of Inspector General estimated $ 4.5 billion in telemedicine-related fraud last year.

Government Accountability Office health officials warned the Senate Finance Committee last month of potential fraud and increased spending, adding that it was unclear how an extension of the guidelines would affect the quality of care. The Congressional Budget Office noted last year that a plan that would end Medicare’s geographic restrictions on mental health care via telemedicine would add $ 1.65 billion in spending between 2021 and 2030.

The CBO noted last year that an earlier bill, HR 5201 (116), which would lift Medicare’s geographic restrictions on mental health care via telemedicine, would increase spending by $ 1.65 billion between 2021 and 2030.

“We’re still in an uphill battle with [congressional scorekeepers]”Said Tom Leary, senior vice president of government relations for the Healthcare Information and Management Systems Society. “The question of possible overutilization is the biggest problem.”

The Schatz Plan would end all location restrictions on telemedicine for Medicare beneficiaries, allow patients to take care of their homes, and rural health clinics and health centers providing care in underserved areas that enable continued use of telemedicine. Prior to the pandemic, Medicare only covered telemedicine in certain rural areas and required patients to travel to appropriate health facilities to access telehealth services.

It would also allow the Minister of Health and Human Services to permanently lift restrictions on telemedicine and commission a study on the use of telemedicine during the Covid-19 pandemic. HHS Secretary Xavier Becerra has signaled support for raising the curbs.

More than half of the states permanently eased restrictions on telemedicine this year, while others are considering laws to expand access. Several other proposals on telehealth were also tabled in Congress.

Proponents have said the legislation would be a win-win for patient access and health care, and cite the support of numerous provider groups such as the American Medical Association.

“It avoids what we call the telemedicine cliff,” said Kyle Zebley, public policy director for the American Telemedicine Association. “If Congress fails to act and the health emergency is declared over at some point in the not-too-distant future, then all of the regulatory flexibilities that telemedicine has made available to all Medicare recipients will disappear.”

Proponents of the legislation are confident that they will at least include an extension of telehealth flexibility in the law this year to avoid a possible backlash of access. HHS said in a letter To governors that the public health declaration to lift restrictions on telehealth is likely to remain in place until the end of 2021.

Schatz intends to bind the legislation to a bill that could include a year-end contract. If that fails, lawmakers could opt for a temporary extension that will gain time to collect more data on post-pandemic virtual care. This would follow the recommendations of MedPAC calling for an extension for a year or two after the end of the public health emergency.

Influential lawmakers who failed to sign up include Senate Finance Chairman Ron Wyden, D-Ore. And House Ways and Means Health Subcommittee Chairman Lloyd Doggett (D-Texas), whose tax committees are responsible for Medicare. Doggett – who has raised concerns about the permanent expansion of telemedicine before further studies are conducted – has announced plans to put in place laws to extend telemedicine exemptions in order to collect more data.

However, some telemedicine proponents say that there is already enough data to show that fewer appointments are missed and certain virtual services are just as efficient as face-to-face care.

“Congress will always ask for more dates,” said Sarah-Lloyd Stevenson of Faegre Drinker. “My fear is that even if you extend it for two years, they will ask for more data.”

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