The Senate Committee on Health, Education, Labor & Pension https://www.help.senate.gov held a hearing on June 17, 2020 to hear from a panel of telehealth experts that provided testimony on the key role telehealth has played in fighting the spread of COVID-19 and what the telehealth industry needs to do to maintain momentum from a regulatory perspective to move forward.
Witnesses included Karen Rheuban, M.D, Director of the Karen S. Rheuban Center for Telehealth at UVA, https://uvahealth.com Joseph Kvedar, M.D., President, American Telemedicine Association (ATA) https://www.americantelemed.org, Sanjeev Arora. M.D., Founder & Director of Project ECHO https://echo.unm.edu, and Andrea Willis, M.D. CMO of BlueCross BlueShield of Tennessee https://www.bcbst.com.
Credit Suisse’s analysts highlighted the key takeaways. The two key telehealth regulatory waivers seem to have unanimous support to be made permanent. While Committee members agree that it is still early in terms of understanding the implications from the rapid expansion in virtual care, Committee Chairman, Senator Lamar Alexander suggested that the three major federal changes for the use of telehealth in response to COVID-19 (i.e. originating site, expansion of covered telehealth services by Medicare/Medicaid, and HIPAA relaxations), the originating site rule, and the expansion of covered telehealth services by Medicare/Medicaid should be made permanent.
Senator Alexander recommended making changes before the end of the year so new telehealth patients aren’t suddenly cut off from their providers. In fact, he noted in his prepared remarks, “Even with an event as significant as COVID-19, as memories fade and if attention moves quickly to the next crisis, it is important for Congress to act on legislation this year.”
Committee members also noted that they would push for other telehealth related changes in upcoming coronavirus relief bills. However, some members indicate that any extension of the HIPAA privacy waivers should be considered carefully.
Dr. Willis noted that BlueCross BlueShield of Tennessee paid at parity for telehealth going into the pandemic, and that the insurer is not in a rush to abandon that practice. She indicates, that BCBS will be looking at the data for expected efficiencies, but overall, BCBS does not want to inject additional cost into the healthcare system. The conversation over payment parity was left as a topic that needs to be further evaluated by lawmakers and private payer stakeholders.
In response to a question as to whether expanding the amount of covered telehealth services increases costs, Dr. Willis replied that the health plan is still accumulating data and it is too early to have a definitive conclusion on that issue.
However, Dr. Willis did note that the health plan expects to gain efficiencies, by keeping people out of the ER who don’t need to be there, as well as provide care to people who otherwise would have forgone care. These efficiencies should result in the health plan saving money in the long run.
Audio-Only Visits was a key talking point for Senators. Aside from video visits, Senators seem to be interested in the effectiveness of audio-only visits as opposed to video or in person visits. Telehealth experts on the panel, testified that audio-only visits, although not 100% effective relative to a visual inspection of a patient, do help address the disparity especially in populations that lack proper access to broadband.
Dr. Rheuban indicated that of all the telehealth visits conducted by UVA Health since the start of the pandemic, one-third have been audio-only, which were in most cases conducted where there was an existing patient/provider relationship. Although, not everything can be done via audio-only, each of the telehealth experts indicated that it can be used as a valuable tool to help reduce disparities in obtaining care.
Dr. Arora indicated that 80% of the information needed during a patient visit is historical, while the remainder comes from the actual physical exam. As a result, a simple telephone visit can provide great value in certain situations.
Discussion was held on the viability of remote patient monitoring although not the main focal point of the hearing. Senator Jones was quick to ask questions as to the viability of remote patient monitoring to address the needs of people living with chronic conditions.
Dr. Kvedar noted that Congress should encourage those in the private payer market to come on board and support the use of codes for remote monitoring. Dr. Willis of BCBS indicated that the health insurer already has coverage for remote patient monitoring in their Medicaid population, but BCBS is currently looking at the lessons learned to see how it can be applied to their commercial members.
Some successful points on telehealth utilization were brought up at the hearing. For example, in Senator Alexander’s opening remarks, it was noted that Ascension Saint Thomas, a nine- hospital health system in Tennessee was conducting abound 60K visits per month pre-COVID which turns out that only around 50 were via telehealth. However, during the last two months, around 45% of all visits have been converted to telehealth, and the CEO of Ascension expects telehealth visits to settle down at 15% of total visits going forward.
Also, the largest hospital in San Francisco was conducting around 5% of all visits via telehealth in February, but when the pandemic hit in March, telehealth visits were making up more than half of all visits.
Lastly, Dr. Kvedar indicated that Partners HealthCare has conducted 605K virtual visits in the last three months which included 247K in May alone. Pre-COVID, the health system had been conducting just 0.2% of all ambulatory visits via telehealth, but is now anticipating that post COVID, that number will move to 60% of all ambulatory care being delivered remotely.
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