Telehealth benefits need extension with 2 key guardrails, policy expert says

We may be nearing the edge of the “telehealth cliff,” which refers to the potentially abrupt elimination of pandemic-era virtual care benefits as the severity of Covid-19 abates nationwide. 

The federal policies that have allowed telehealth coverage and waived in-person clinician visit requirements for prescriptions are in jeopardy once the Covid-19 public health emergency expires. The PHE is set to expire on October 13, but it is expected to be extended because the Department of Health and Human Services has not provided the 60-day notice it said it would issue once the emergency ends for good. The emergency has been extended multiple times already.

While we don’t know exactly when the PHE will come to an end, it’s important for the healthcare industry to advocate for the extension of telehealth flexibilities for at least two years following the end of the emergency, Julia Harris, senior policy analyst for the health policy project at the Bipartisan Policy Center, said in an interview. She noted that the benefits should be extended but with caveats in two key areas — the prescription of addictive medications and audio-only visits.

Once the pandemic emerged, HHS’ telehealth policy “was to basically turn everything on and remove all the guardrails that had previously been in place,” according to Harris. HHS gave all providers who were eligible to bill Medicare the ability deliver services virtually, as well as allowed providers to use popular conferencing platforms like Zoom and FaceTime for telehealth appointments. The department also expanded Medicare coverage for audio-only visits, and it waived the requirement that patients must have an established relationship with a provider before receiving telehealth services. 

All of these benefits have been tied to the Covid-19 PHE. If they’re not protected once the emergency expires, things will go back to the way they were before the pandemic — most Medicare beneficiaries will lose their access to virtual care unless they live in rural areas or enroll in Medicare Advantage, Harris pointed out.

The Bipartisan Policy Center recently released a report that detailed the massive increase in telehealth utilization since the pandemic. Virtual care accounted for less than 1% of Medicare claims before the pandemic, but the modality jumped to a peak of 32% in April 2020, leveling off to 13-17% by July 2021.

People who were eligible for Medicare because of a disability, those with end-stage renal disease, people with multiple chronic conditions and those who were dually eligible for both Medicare and Medicaid were the cohorts who were much more likely to utilize telehealth, the report found. 

This demonstrates that pandemic-era telehealth flexibilities have “created easier pathways to get care for people who struggle with mobility or who have multiple health problems,” Harris noted. She said eliminating such flexibilities could lead these populations to seek care less, which could lead to negative and potentially fatal health outcomes.

While it’s imperative that the healthcare industry call upon Congress to protect telehealth benefits, there are two key guardrails that should also be advocated for, according to Harris.

The first has to do with the fact that some providers might be taking advantage of looser pandemic rules around prescribing medications. Some virtual mental health care startups, such as Cerebral and Peak, have come under fire this year for indiscriminate prescribing practices for Adderall and ketamine. The Drug Enforcement Administration is even conducting an investigation into Cerebral’s prescriptions.

Harris suggested the federal government set limitations on which kinds of controlled substances can be prescribed via telehealth, recommending that Congress reevaluate its flexibilities for medications that have a potential for abuse or addiction.

The other area of concern is audio-only visits. This flexibility was established during the early pandemic because many Americans faced barriers to using videoconferencing technology, such as not having a smartphone or lacking broadband access.

“But it’s a previously unused modality, and really not a lot is known about the quality of that care. And so what we recommend is that not that it goes away, but that we try to limit that benefit to the people who really have access issues as opposed to just a blanket policy,” Harris said.

She also recommended that audio-only visits be limited to patients who have an existing relationship with their provider, as this creates less risk than if a provider were to meet someone over the phone for the first time and immediately begin delivering care.

Photo: Alisa Zahoruiko, Getty Images