Telehealth for All Medicare Patients Hinges on Congress

Seeing medical professionals through telemedicine appointments shot up during the COVID pandemic. (UAMS)

If Congress doesn’t extend telemedicine regulations for Medicare patients by the end of the year, it will deliver a sharp blow to an industry that gained popularity during the COVID pandemic.

“What it means on Jan. 1 is, if we don’t have clarity to the rules, we may end up rescheduling telemedicine visits for in-person visits because we may not be confident that we can offer … telemedicine video visits for medical services to the home,” said Dr. Joseph Sanford, the director of the University of Arkansas for Medical Sciences Institute for Digital Health & Innovation.

Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, said he expects the regulations — which assure that telemedicine visits will be covered for all Medicare recipients — to be extended for another two years, but congressional approval might not come until December.

“We’re expecting to have success on several of these fronts, but some of the other fronts are uncertain and we’re sweating it out,” Zebley said.

Telehealth regulations were temporarily loosened on an emergency basis early in the pandemic in 2020, he said.

If the rules aren’t extended, Medicare patients will be “dragged back not just to 2020 but to 1997 in terms of telehealth access,” Zebley said.

In 1997, Congress approved the experimental technology and approved Medicare payments for telehealth services if the patient lived in a defined rural area and the person was present in a provider’s office.

In 2020, those restrictions were waived.

But, barring congressional action, those restrictions and others will return on New Year’s Day.

Setting the Standard

Zebley said that when Medicare doesn’t cover a service, it often sets a trend that spreads through the health care system.

“Medicare Part B is still the single largest payer in the United States health care system, and it has tremendous credibility in terms of coverage determinations,” he said. “If Medicare determines to cover something, it tends to act as something of a floor for all other payers, both commercial and public.”

The uncertainty surrounding telehealth regulations comes at a time when most patients enjoy the convenience and speed of telehealth care and expect visits to be covered by their insurance carrier, Christopher Lis wrote in an email to Arkansas Business. Lis is managing director of global health care intelligence at J.D. Power of Troy, Michigan, which provides consumer insights and offers advisory services as well as data and analytics.

But the most significant barriers to use include internet connectivity, limited services and data security, according to a survey that J.D. Power released last month.

In 2023, 72% of those surveyed said they experienced barriers during telehealth visits; a year later that share had dropped to 65%, “so the sector is improving,” Lis said.

Heartland Forward of Bentonville is working to increase telehealth access in Arkansas and Oklahoma. Last week it announced that it will provide training to librarians in both states who will then teach the public how to use telehealth technology.

The Public Library Association and Ford Foundation of New York created the project. A $25,000 grant from the James M. Cox Foundation, named after the founder of Cox Enterprises of Atlanta, will be used to expand the project in Arkansas and Oklahoma.

Expanding Services

Telehealth services have been expanding since the pandemic. “There’s been really a continued sea change for telehealth,” Zebley said. “Now it’s a household term that most Americans have had experience with and have come to rely on and trust.”

But telehealth is still difficult for some companies.

In April, Walmart of Bentonville said it was closing Walmart Health and Walmart Health Virtual Care. “We determined there is not a sustainable business model for us to continue,” the retailer said in a news release.

UAMS’ Sanford said telehealth can be a challenging market, citing  high infrastructure costs as well as limited availability of providers.

“So you get your best economy of scale when you’re able to see a lot of patients,” Sanford said.

Most patients will use their smartphone for a telehealth visit. But some patients don’t have enough data available through their smartphone plan for a high-quality telemedicine visit. “For some of our patients, that can be a challenge,” he said. “Data plans can be expensive.”

Sanford said that UAMS has seen a slight dip in telehealth patient visits in the last quarter to between 1,100 to 1,200 visits weekly.

But the telehealth visits shoot up when there’s bad weather. During a week of winter weather in January, UAMS had about 4,000 telehealth visits.

Had telehealth not been available, he said, those patients would have had to reschedule their appointments.

Other COVID-era exemptions are also set to expire on Dec. 31. One involves Medicare payments for telehealth mental services that was made permanent at the end of 2020, but it became encumbered with the threat of a blanket in-person requirement for providers, he said.

“It’s never taken effect, and we’ve been able to forestall the implementation of that in-person requirement,” Zebley said.

‘Devastating to Access’

That means if Congress doesn’t change the in-person requirement, on Jan. 1 Medicare beneficiaries who need mental health services online will “have to go through the hard work of finding a magic unicorn mental health provider who will see them both in-person and will maintain that relationship via virtual means,” he said.

With a mental health provider shortage, it’s “going to be really devastating to access,” he said.

Zebley also wants Congress to extend a COVID-era waiver from the Drug Enforcement Administration that allows providers with prescribing authority to prescribe controlled substances remotely. That exemption also expires at the end of the year.

“Since that waiver has been put in effect and kept in effect, we now have a whole host of patients that are relying on these flexibilities to receive care from licensed medical professionals in areas of addiction treatment, psychiatric care and other areas of clinically appropriate care,” Zebley said.

The DEA is supposed to come up with a permanent solution but hasn’t, he said.

Zebley hopes that President Biden’s administration or Congress extends the waiver.

“Medical professionals are saying you can do a whole host of areas of care virtually,” Zebley said. “If that wasn’t the case, this would all be pointless.”