“Telehealth has kept the entire health care system afloat and has enabled patients to continue to receive care,” the American Telemedicine Association’s president said in a testimony.
In a testimony before the full Senate Committee on Health, Education, Labor and Pension (HELP), American Telemedicine Association (ATA) President Joseph Kvedar, MD, urged policymakers to “take specific actions before the end of the public health emergency to make access to telehealth services permanent.”
Kyedar, who is a professor at Harvard Medical School and senior advisory of virtual care at Massachusetts General Hospital in Brigham, explained the immense benefits created from telehealth initiatives amid the novel coronavirus disease 2019 (COVID-19) pandemic, including Congress’ and the federal government’s lifting of many outdated barriers to telehealth and remote patient care. Without these obstacles, Kvedar asserted that telehealth has saved lives, helped reduce the spread of COVID-19, and assisted in scaling responses from the overwhelmed health care system.
During the testimony, the Senate asked witnesses to describe how eased regulations have improved access to care, and which policies they believe should remain permanent when the public health emergency ends.
ATA aims to ensure that patients – including Medicare beneficiaries – continue to be empowered with the option to use telehealth through rapid reform by way of legislation.
Kvedar shared with Congress his commitment to telehealth through the numbers: In the last 3 months of the pandemic, health care providers working with ATA completed more than 605,000 virtual visits, including nearly 247,000 in May alone. Post-pandemic projections similarly express the upswing in telehealth services, as they show that Mass General Brigham providers will go from about 1500 virtual visits per month to 250,000.
Pre-COVID, a mere .2% of all ambulatory outpatient visits were through telehealth. Kvedar asserted that his hospital anticipates 60% of ambulatory care being delivered remotely.
Telehealth has the critical potential to address gaps in health care in the United States, according to the testimony: “I have seen firsthand the multitude of ways telehealth has bridged the gap between a critical provider shortage and a growing patient population—a problem that existed before the pandemic, and one that will only worsen due to an aging population and the increasing burden of chronic disease.”
Kvedar used his own telehealth clinic as an example of its potential to address underserved populations. Indeed, COVID-19 has also disproportionately affected minority populations, and barriers to provider care compound the problem.
“Health care providers and policymakers often talk about the urgent need for health care transformation to address the challenges we are facing, including rising provider shortages, burgeoning patient populations, and growing financial pressure. COVID-19 has fueled a rapid transformation, with telehealth and virtual care driving the new paradigm in care delivery.”
The testimony to Congress illuminated that telehealth functions much more broadly than real-time audio or video calls between patient and provider; many platforms are combined with remote monitoring capabilities. This expanded care model means that telehealth technologies can also allow for a virtual care model that offers patients around-the-clock clinical support and convenience for those patients with chronic conditions and therefore engage with their provider and health care system often—diabetes, hypertension, congestive heart failure, and behavioral health conditions among them.
With 90% of total health care costs stemming from treatment of chronic conditions, telehealth has the potential to improve access to provider care, while also reducing much of the acute and long-term health complications that result from chronic conditions.
Temporary amendments to the Social Security Act’s 1834(m) section, which Kvedar considers “unnecessarily restrictive,” have allowed all Medicare beneficiaries, including those living in rural and urban areas, to benefit from telehealth.
Among ATA’s specific requests to Congress were addressing current Medicaid statutory restrictions on patient geography and originating site limitations, both of which are outdated, according to Kvedar. Congress should also make sure the Secretary of the Department of Health and Human Services (HHS) expands the list of eligible practitioners and therapy services, and allow the Centers for Medicare and Medicaid (CMS) to determine and manage telehealth services through a “predictable and transparent regulatory process” in order to effectively pursue clarity and certainty in regards to the future of telehealth.
Kvedar lauded Congress for supporting treatment of the United States’ most vulnerable populations through Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) as distant sites under the CARES Act, but also pushed for fair and appropriate reimbursement—a factor that Kvedar deemed one of the most critical barriers at the federal level to telehealth in a post-pandemic United States. Another critical need is building either on existing telehealth infrastructure through funding of targeted grants and technical assistance programs at the Federal Communications Commission (FCC) and Health Services and Resources Administration, or alternatively launching new infrastructure under HHS.
Kyedar noted that although these are not the only policies that must be made to allow for telehealth expansion post-pandemic, they are the most pressing ones that must be addressed. Policymakers must initiate these permanent telehealth improvements before it’s too late.
“Now that Medicare beneficiaries have improved access to telehealth, federal policymakers need to take specific actions to make these services permanent. Failure to do so will result in unnecessarily restricting access to high-quality care. However, if the federal government—and specifically Congress—does not act before the end of the declared national public health emergency, Medicare patients and providers will not have the option to continue to use remote care,” Kvedar said.