Congress Expected to Delay Decisions on COVID-Era Telehealth Policies

Nearly two hours into a Capitol Hill hearing on rural health, Rep. Brad Wenstrup urged the committee’s five witnesses to “hang with us.”

Federal lawmakers face a year-end deadline to decide whether to keep or discard various COVID-era telehealth payment changes, which allow patients to see doctors or therapists from home.

At the early March hearing, Wenstrup and other House members shared personal stories about how telehealth, home visits, and remote monitoring benefited their patients, relatives, and constituents. Wenstrup, a Republican from Ohio and a podiatric surgeon, stated, “Patients are less anxious and heal better when they can be at home.”

Most proposals focus on how Medicare covers telehealth services, but these rules also affect all insurance plans since private insurers and some government programs typically follow Medicare’s lead. Without congressional action, services like audio-only calls or online meetings with specialists could end. The bills would also allow rural health clinics and other centers to offer telehealth services while waiving the requirement for in-person mental health visits.

Telehealth use surged during the early months of the COVID-19 pandemic and has become a popular issue for lawmakers from both parties.

A U.S. Census Bureau survey from April 2021 to August 2022 found that 26.8% of Medicare enrollees and 28.3% of Medicaid enrollees used telehealth. The survey of nearly 1.2 million adults also revealed high telehealth use among Black patients and those earning less than $25,000, with people of color more likely to use audio-only visits.

Ensuring access to telehealth services is “the best public policy,” said Debbie Curtis, a vice president at McDermott+Consulting. “It’s the best business outcome. It’s the best patient care outcome.”

However, Curtis noted that Congress is a “deadline-driven organization” and expects delays until after the November election.

Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, said Congress might address the issue during the lame-duck period. “This is no way to run a health care system on a popular bipartisan issue,” he said.

In January, lawmakers, including senators from Mississippi and South Dakota, urged the Biden administration to work quickly with Congress to ensure continued payments for Medicare patients using telehealth, especially in rural and underserved areas.

Maya Sandalow, a senior policy analyst at the Bipartisan Policy Center, suggested that lawmakers might consider a temporary extension of payments rather than permanent changes. “Research is still coming out covering more recent years than the acute effects of the pandemic,” she said. The center plans to release policy recommendations soon.

Key questions include which health care services are best for audio-only and video visits. Researchers are also exploring how telehealth can expand access to affordable, high-quality care while ensuring in-person options remain.

In North Dakota, Sanford Health’s David Newman said virtual care is often the only way some patients in the western part of the state can access sub-specialty care, such as behavioral health. Newman, an endocrinologist and Sanford’s medical officer of virtual care, noted that 10% to 20% of his patients are seen virtually in the summer, compared to about 40% in the winter due to impassable roads.

Previously, Newman would sometimes “do nothing for a day” during winter because patients couldn’t reach him. Now, he has a full clinic thanks to telehealth technology. “I tell my patients that if you can make a restaurant reservation or order a pizza online, you can do a virtual visit,” he said.