Lose the COVID-19 public health emergency, but keep the progress
When President Joe Biden recently declared on national television that “the pandemic is over,” he offered a glimpse into the strategy his administration will be using on COVID-19 going forward: We’re ready to move on.
Biden’s statement, which divided the public health community and the public, has wide-reaching implications for the fate of connected health and vital telehealth services.
In January 2020, then-Secretary of the U.S. Department of Health and Human Services Alex Azar signed the first Public Health Emergency declaration, declaring COVID-19 a national emergency. The PHE has been renewed every 90 days and is currently set to end on Oct. 13, 2022, unless it’s renewed yet again.
All signs point to the PHE extending for another 90-day period until January 2023 because the 60 day advance notice wasn’t given in August, but the president’s latest statement indicates this could be the final renewal, and the PHE may finally expire in the new year.
Without action from Congress, most of the telehealth flexibilities will cease, cutting off telehealth access to a majority of Medicare beneficiaries. It would also stall much-needed progress to fully integrate telehealth as a central element of healthcare delivery. We cannot afford to let that happen. Patients and providers deserve to have continued access to every tool at their disposal.
COVID-19 forced the healthcare industry to adapt in many ways, and the rules relaxed by the PHE declaration enabled rapid progress in many areas, including virtual care. The nation’s leaders are now declaring the pandemic is over; then they must ensure that the easily accessed, high-quality care systems we’ve built, and have come to depend on, don’t terminate along with it.
What this means for telehealth and connected health policy
The signing of the first COVID-19 PHE, the decisive legislation passed by Congress in March 2020 (the Coronavirus Preparedness and Response Supplemental Appropriations Act and the Coronavirus Aid, Relief and Economic Security [CARES] Act), and key actions taken by states, allowed HHS to enact several waivers and flexibilities that tore down decades-old barriers to telehealth. They ushered in an unprecedented wave of connected health technologies, particularly for Medicare beneficiaries.
Between March 2020 and February 2021, over 28 million Medicare beneficiaries, or more than 40%, used telehealth services. This is an astounding 88 times more telehealth used during the first year of the pandemic, compared to the year before. The adoption of high-quality connected health by clinicians and healthcare organizations was swift, and access to these new means of high-quality care by patients have been transformational.
Despite the progress of the past two and half years toward realizing the future of healthcare delivery, significant uncertainty remains. Many of the telehealth flexibilities that have expanded access, saved lives, advanced health equity and improved efficiencies are temporary and, thanks to an act of Congress, will now expire 151 days after the end of the COVID-19 PHE. These telehealth flexibilities could disappear as early as June 2023 without additional congressional action.
Complicating congressional considerations are the persisting concerns that expanded telehealth use poses increased program integrity risks for the Medicare program. The real-world examples of widespread waste, fraud, or abuse are minimal, but the mere threat to further strain the Medicare program has slowed the momentum around further telehealth legislation.
A recent HHS Office of Inspector General report found that fewer than 0.3% of Medicare providers engaged in telehealth billing practices that pose a high risk to Medicare that may indicate fraud, waste, or abuse. The OIG recommended an “effective, targeted oversight of telehealth services to ensure that the benefits of telehealth are realized while minimizing risk.”
Recognizing the urgency to avoid any sudden loss of access to care for millions of Americans, the House of Representatives overwhelmingly passed an additional two-year extension of telehealth flexibilities, the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040), with a strong bipartisan vote of 416-12.
In support of this move, HIMSS recently co-led a letter signed by hundreds of organizations to U.S. Senate leadership urging them to take up the legislation. Its passage would remove the uncertainty and lay out a clearer path toward a permanent, comprehensive expansion of telehealth and connected health policies.
Why this is so important
At the start of the pandemic, the nation’s healthcare system made critical investments in new technologies, time and resources to meet the immediate and unique challenges brought on by COVID-19. These investments catalyzed new infrastructure that would support America’s healthcare resiliency and possible future needs.
The prolonged uncertainty around telehealth permanence is driving providers to weigh the costs of sustaining these investments to maintain telehealth programs against the possibility that the U.S. may return to pre-COVID policies that severely restricted telehealth adoption and access.
A silver lining of the pandemic is that connected health has become a fundamental part of the U.S. healthcare system. Studies have shown time and again that increasing the use of telehealth would improve patient access to high quality care and strengthen continuity of care well beyond the COVID-19 pandemic. Telehealth has been instrumental in supporting pediatric care, treating substance-use disorders and reaching patients with behavioral health disorders.
It must be said that telehealth does have its limitations, particularly when a physical examination is warranted. And for many Americans, certain factors such as broadband availability, limited digital inclusion, and digital health literacy can negatively impact any possible benefits of telehealth.
These disparities further bolster the argument that we need to address the critical issues of equitable access. Telehealth must be a tool to eliminate disparities and advance health equity, not exacerbate them.
Still, in many ways, telehealth has supported greater patient access, mitigated the impact of the increasing workforce shortages across all healthcare professions, and helped ease widespread stress and burnout. The workforce shortage is only expected to get worse as the world emerges from the COVID-19 pandemic. Any action or inaction that risks jeopardizing the progress made with telehealth is likely to have dire consequences for both healthcare professionals and patients alike.
What’s more, patients have come to greatly appreciate the benefits and convenience that telehealth offers. While telehealth is not a new concept, the COVID-19 pandemic exposed most Americans to telehealth in action, many for the first time. Based on their positive experiences, patients have become overwhelmingly supportive of retaining the option for telehealth long after the pandemic is over.
What comes next
The pandemic’s wake has exposed the public to telehealth and connected health in a way no one could have predicted. Barriers to telehealth were toppled overnight, and investments in technologies skyrocketed to meet the growing demand. The policy changes that accommodated and even accelerated this remarkable growth were temporary, however, and the investments were predicated on the assumption that the country wouldn’t revert to pre-COVID policies.
The current and previous administrations have expressed support for telehealth permanence. “I think the genie’s out of the bottle on this one.” said the former HHS Centers for Medicare & Medicaid Services Administrator Seema Verma in June 2020. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”
A year later, when speaking about making telehealth expansion permanent, current HHS Secretary Xavier Becerra said, “We are absolutely supportive of efforts to give us the authority to be able to utilize telehealth in greater ways. We want to make sure that we don’t leave anyone behind.”
At the end of 2022 and the 117th Congress, the U.S. is getting closer to the anticipated end of the PHE and the beginning of the 151-day countdown. Healthcare communities must urge the Senate to pass critical telehealth legislation. The Senate must follow the House of Representatives and pass at least a two-year extension of these important policies while working toward a permanent solution.
David Gray is director of government relations & connected health policy at HIMSS.