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It's time to talk about telehealth (again)

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Jun 13, 2023
Illustration of a physician's hand holding a stethoscope coming out of a laptop screen.

Illustration: Gabriella Turrisi/Axios

Congress is picking up where it left off with telehealth at the end of 2022.

Why it matters: Lawmakers have until the end of 2024 to figure out what's next for Medicare and private insurance telehealth flexibilities that transformed health care during COVID-19 after a two-year extension passed late last year.

  • Advocates' goal over the next 18 months: Prevent telehealth from becoming another health care extender. It's easier said than done.

Driving the news: After a quiet winter and spring on the telehealth front, activity ramped up this month.

  • Ways and Means last week advanced a bill that would permanently allow people with high-deductible health plans and health savings accounts to access telehealth services before hitting their deductible.
  • The Education and Workforce Committee is holding a postponed markup on another telehealth bill this afternoon.
  • Lawmakers hope to reintroduce the CONNECT for Health Act — which would permanently extend major Medicare telehealth benefits — this week, a Democratic aide told Axios.
  • Another bipartisan bill to permanently authorize outpatient therapy providers, including physical and speech therapists, as Medicare telehealth providers was introduced last week.

Between the lines: The end of the flexibilities may seem far away, especially in congressional terms.

  • But "nobody wants to be running around next year with our hair on fire trying to get another extension," said Krista Drobac, executive director of telehealth advocacy coalition Alliance for Connected Care.
  • "We're really happy to see this process taking place now," Drobac said. "We don't want to be trying to get something done and then all of a sudden at the eleventh hour, a committee is saying hey, wait a minute, we haven't had input here."

Where it stands: Telehealth has "unbelievably widespread support" on Capitol Hill, said Joe Ganley, vice president of government relations and regulatory affairs at health tech company Athenahealth.

  • "Expanding telehealth services is critical to ensure patients have access to care," Ways and Means Chair Jason Smith said last week during a mark-up. "I look forward to additional efforts this committee will take in regard to telehealth in the months to come."

Yes, but: The perennial issue with making telehealth flexibilities permanent is cost.

  • Permanent Medicare telehealth could come at a price of $25 billion over 10 years, the Committee for a Responsible Federal Budget extrapolated from CBO scores for short-term extensions.
  • Advocates point to data indicating telehealth hasn't led to duplicative care or widespread fraud — two issues that CRFB and other experts caution could inflate telehealth's costs.
  • But staff for the Medicare Payment Advisory Commission said in April that more evidence on telehealth outcomes and effects is needed before making permanent policy decisions.

What's next: Lawmakers may have an easier time hashing out a plan for permanent telehealth in the commercial market than in Medicare, since the latter requires examination of the quickly-depleting Medicare trust fund, Drobac predicted.

  • Another telehealth lobbyist told Axios that an additional short-term extension for Medicare telehealth policies is likely.

The bottom line: "We want permanent legislation, [but] we don't want nothing," Drobac said. "We'll take an extension if necessary."

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