Lock In Telehealth Flexibility, Protections, Says AAFP

Academy, Other Groups Warn Congress of Impending Telehealth 'Cliff'

July 02, 2020, 01:58 pm News Staff – Telehealth flexibilities implemented in response to the COVID-19 pandemic clearly work and should be made permanent, the Academy and more than 300 other national, regional and state health care organizations told congressional leaders in a June 29 letter.

At the same time, the AAFP advised lawmakers in a July 1 letter co-signed by the American Academy of Pediatrics and the American College of Physicians, any such policy update must support the medical home and discourage fragmentation of care.

The need for legislative action is urgent. Although HHS said it plans to extend the designation of a public health emergency past the previously announced date of July 25, the waivers that allowed for rapid expansion of virtual care during the pandemic expire when the emergency ends.

"We need your support in ensuring that seniors and providers do not go over the telehealth 'cliff' -- losing access to these critical services when they are still needed by so many," wrote the coalition in the June 29 letter, which called on Congress to broaden CMS' telehealth authority under the Social Security Act and "build on temporary reforms included in the Coronavirus Preparedness and Response Supplemental Appropriations Act and the Coronavirus Aid, Relief and Economic Security Act."

That letter was sent to Senate Majority Leader Mitch McConnell, R-Ky.; Senate Minority Leader Chuck Schumer, D-N.Y.; House Speaker Nancy Pelosi, D-Calif.; and House Minority Leader Kevin McCarthy, R-Calif. Among its co-signatories were the American College of Physicians, the Primary Care Collaborative and the North American Primary Care Research Group.

The widespread expansion of telehealth services during the COVID-19 public health emergency -- a result of HHS' and CMS' temporary relaxation of longstanding restrictions on Medicare telehealth services and similar allowances for other health care providers -- has been a silver lining of the pandemic. Some 11.3 million beneficiaries used telehealth services in mid-April alone, the June 29 letter noted, and 91% of seniors on Medicare Advantage plans have reported favorable experiences with telehealth. Private carriers likewise cited a 4,300% year-over-year increase in telehealth claims for March 2020.

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"Seventy-six percent of Americans now report having a strong interest in using telehealth moving forward," the groups wrote.

To ensure that HHS and CMS have the necessary authority to carry forward that momentum and maintain oversight of telehealth services while updating "outdated statutory restrictions that discriminate based on geography and patient location," the groups outlined four key legislative goals. Congress, they wrote, should

remove the obsolete geographic and originating site restrictions in the Social Security Act to ensure that all patients can access care at home and other appropriate locations, as the Academy has long advocated;
maintain and enhance HHS' authority to determine appropriate providers and services for telehealth;
ensure that federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency; and
make permanent HHS' temporary waiver authority for future emergencies.

"Congress not only has the opportunity to finally bring the U.S. health care system into the 21st century, but the responsibility to ensure that billions of dollars in COVID-focused investments made during the pandemic are not wasted and instead are used to support the transformation of care delivery and, ultimately, expand access to high-quality virtual care to all Americans," the letter said.

"Swift congressional action will provide a clear signal to patients, who are concerned about the future of their telehealth benefits, as well as providers and health systems, which are hesitant to make investments in critical health care infrastructure without certainty from policymakers."

The July 1 letter -- sent as a follow-up to the Senate Committee on Health, Education, Labor and Pensions' recent hearing on telehealth lessons of the pandemic and addressed to Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., the committee's chair and ranking member, respectively -- offered further guidance.

"We wholeheartedly agree with Chairman Alexander's assertion that 'personal relationships involved in health care … cannot always be replaced by remote technology,'" wrote the Academy and its co-signatories. "Therefore, as the committee considers permanent changes to telehealth beyond the current public health emergency, we urge you to ensure that the flexibility to offer telehealth services be balanced with safety and quality, in addition to promoting and supporting the medical home."

Again, the correspondence depicted the newly changed telehealth landscape as a significant advance -- as long as the regulatory environment around it remains supportive.

To that end, the July 1 letter repeated the call to permanently remove the geographic and originating site restrictions from the Social Security Act. It also laid out four principles to guide lawmakers as they ponder telehealth updates. Telehealth, the groups wrote, should

be covered at equitable rates determined by the care provided rather than by the technology employed;
enhance the physician-patient relationship, not disrupt it, with health plans prohibited from limiting or steering patients to receive care from virtual-only telehealth vendors;
be supported by federally funded research and demonstration projects to address workforce needs, expand patient access to care, improve quality of care, reduce health care costs and ensure satisfaction; and
be enabled by expanded access to broadband internet, as supported by Congress, to reduce health disparities and gaps in care access.

Citing a recent survey of AAFP members, which found that 81% of family physicians had begun providing virtual visits for the first time during the pandemic and 69% expressed interested in continuing to provide such care, the letter asked the committee to alleviate "the uncertainty around future waves of COVID-19 outbreak, which could lead to new stay-at-home orders."

"Physicians need to be able to quickly pivot between providing in-person and virtual care," the letter added, with the latter centered on "an intention to provide care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety."