With a deadline to extend current telehealth reimbursement policies fast approaching, a bipartisan group of policy advocates is calling on legislators to make telehealth a permanent fixture of US healthcare — and to simultaneously tighten oversight of potential fraud or compromised care quality.
Telehealth reimbursements initially put in place during the COVID-19 public health emergency have garnered wide support from providers for continuing to allow greater flexibility and providing access to patients who may have difficulty accessing in-person care — such as seniors, and especially those living in rural areas.
But some concerns have lingered about the potential for easier fraudulent acts and the difficulties some senior care providers may have in providing quality care virtually for high-acuity patients. The report also notes concerns that poorly designed reimbursement policies might incentivize providers to move to fully virtual care to the detriment of care that would be better done in-person.
The Bipartisan Policy Center released a report Monday that toed the line between those concerns and the growing excitement for the future of telehealth in long-term care and other healthcare sectors.
“It is critical for Congress to preserve telehealth access and commit to 1) establishing a more sustainable, long-term telehealth reimbursement strategy, and 2) ensuring high-quality virtual care through robust oversight and quality assurance,” the report’s authors wrote.
Noting that they expect a bipartisan extension to pass through Congress before the deadline at the end of the year, the authors laid out the steps they would recommend for making a more stable, evidenced telehealth system in the long-term.
The report calls on Congress to commission the Centers for Medicare & Medicaid Services for a report on telehealth reimbursement by 2026, which would include new reimbursement proposals for “hybrid” care.
That timeline would allow for data from after the peak of the pandemic to be properly studied, the authors said, as well as establishing more firmly how much telehealth costs both providers and Medicare.
Make PT, OT provisions permanent
The authors, however, called for some more well-understood facets of telehealth allowances to be made permanent immediately.
“Policymakers should push for permanent telehealth policy where the evidence warrants it,” they wrote, arguing for lowered geographical restrictions and permanently folding in healthcare that currently only has temporary telehealth allowances.
This would include treatments such as physical therapy and occupational therapy, which are often provided to long-term care residents.
“Permanent policy will provide stability for patients and providers and offer the certainty needed for health systems and practices to feel comfortable investing in telehealth technology,” the authors suggested, echoing the advocacy of provider groups and industry advocates.
At the end of 2023, more than 60% of nursing homes were using telehealth, though this is lower than the 92% peak in 2020.
The report continues to request more financial investment in CMS and other regulators’ oversight efforts.
“Congress should … ensure oversight agencies have sufficient funding to uphold high-quality virtual care, robustly monitor telehealth and track fraud, waste and abuse,” they wrote. “Congress should also require [the Department of Health and Human Services] to delve into key areas with significant quality variability — such as teleprescribing and audio-only — in subsequent evaluations. Adequate resources will ensure that the rapid expansion of telehealth does not compromise the quality of patient care or the integrity of the Medicare program.”
The report’s authors were all affiliated with the Bipartisan Policy Center — Julia Harris, the center’s director; Maya Sandalow, senior policy analyst; Mikayla Curtis, project associate; and Marilyn Serafini, executive director.
