Telehealth’s future after the end of the public health emergency

When the current public health emergency ends, so do many of the waivers put in place to help providers through the pandemic. Telehealth is the big exception, getting an additional 151 days before a loss of flexibilities such as the ability for patients to get virtual care from their home.

Congressional action is needed, and lawmakers are expected to act before the telehealth cliff. Members may need all of that time to sort through what will be allowed, according to Jacob Harper, partner at Morgan Lewis. 

Everyone has either their own telehealth bill or is a sponsor on a telehealth bill, he said. The Connect for Health Act, which would expand the use of telehealth and remote patient monitoring services in Medicare, has 68 Senate sponsors, but hasn’t come up for a vote yet. 

There are also questions on cost. The Congressional Budget Office scoring of proposed telehealth bills awaits more data on the savings provided by telehealth, such as whether it reduces trips to the hospital, said Harper. 

“Now we have a boatload of data, the number crunchers are getting numbers together,” he said. “At the end of the day though, everyone is on board. They need to get in a room, sit down and make something happen.”

The other issue with telehealth is one of integrity: whether it increases fraud and waste in the healthcare system, Harper said.

As Congress debates, some providers wait to invest, according to Harper. “The big issue is that it’s stalling investment in this area. It makes it difficult for providers, investors to come up with a strategy.”

WHY THIS MATTERS

Waivers have allowed hospitals to continue the business of care.

They have helped alleviate some of the challenges and pain the healthcare industry was feeling at the height of the pandemic and continues to feel, said Michael P. Strazzella, head of Federal Government Relations at Buchanan Ingersoll and Rooney.

The current question is: When can hospitals, physician practices and other providers expect the PHE to end – after being extended 11 times since January 2020? And if it’s extended past its expiration date of January 11, will it be for the usual 90 days, or for a shorter period?

Health and Human Services Secretary Xavier Becerra has promised providers at least a 60-day notice before ending the PHE.

“I think most of the country felt it would have received a 60-day notice leading into the end of this year,” Strazzella said.

But hospitalizations continued for COVID-19 and rose due to cases of RSV and the flu. “Just when we thought we were moving in the right direction, there were new challenges,” Strazzella said.

A big pain point has been staffing shortages. Licensure waivers under the PHE have allowed contract nurses to practice in other states. 

“That help is so critical,” Strazzella said. “We are still dealing with burnout, stress, short-staffing, retirements. While we see healthcare providers continuing to struggle, it does explain why we’re still in a PHE. Only on January 10 will we know … that decision.”

At federal urging, state waivers for licensure has allowed providers to practice across state lines. Most states have since pulled back to pre-pandemic licensing requirements, according to Harper. “The biggest issue is being licensed in all states. That remains a pretty big issue. I wouldn’t expect Congress to touch this.”

Another issue is that of the originating site. Prior to the PHE, telehealth services were allowed in rural areas if the patient was at a physician’s office. The home was not considered an originating site.

Federal waivers allowed for audio-only telehealth. Another issue for Congress, said Harper, is whether video is a necessary tool for treatment. 

A hot-button issue, he said, is whether a law will allow virtual visits only for established patients who have already seen their physician in-person, or for new patients who have never been in the office.

Payment parity in Medicare between in-person and telehealth visits is misunderstood, he said. Medicare doesn’t have different payment rates, but reimbursement is based on the facility.

“Reimbursement,” Harper said, “is an ongoing concern.”