Credit Suisse’s https://www.credit-credit.com reported on the House Committee on Energy and Commerce’s Subcommittee on Health https://energycommerce.house.gov hearing held to discuss The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care.
The hearing came on the heels of the reintroduction of the bipartisan Telehealth Modernization Act in which both the House and Senate would safeguard access to coverage after the COVID-19 pandemic.
CMS waived several policies for coverage and payment of telehealth services that will remain in effect for the duration of the COVID-19 Public Health Emergency. However, a permanent expansion of coverage and payment parity, requires an Act of Congress. Broad support for the permanent expansion of telehealth flexibilities was apparent based in commentary made during the hearing.
For instance, the House Energy and Commerce Health Subcommittee Chair Representative Anna Eshoo (D-CA) said, it’s time to make telehealth flexibilities that were pushed through for Medicare during the COVID-19 pandemic permanent, calling many of the payment policies CMS waived amid the public health emergency outdated.
Megan Mahoney, MD Chief of Staff at Sanford Health Care, a witness at the hearing, added “Based on experience and what we have learned today, these policy changes should be made permanent. She pointed out that the policy changes have dramatically improved access to patient-centered care without increasing overall healthcare utilization. She also recommended that CMS add reevaluating medical licensing restrictions to the list of reimbursed telehealth services and policy.
The Committee Chair and some witnesses raised concerns over widespread telehealth expansion and payment parity as support wasn’t comprehensive. Some concerns were raised over telemedicine driving overutilization of healthcare services as well as the potential for increased fraud and abuse.
For example, Representative Frank Pallone, Jr., Chair of the Energy and Commerce Committee is concerned that the use of telehealth will drive overutilization of healthcare services and he wants to find ways to combat fraud and abuse.
Dr. Ateev Mehrotra, Associate Professor of Healthcare Policy, Harvard Medical School raised concerns that in some circumstances, telemedicine is too convenient and translates into more care which results in increased healthcare spending. He also recommended that telemedicine visits be paid at a lower rate than in-person visits as virtual care will have lower costs.
Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, noted that without proper oversight by policymakers and purchasers, greater use of telehealth could lead to increased fragmentation, duplicative and unnecessary spending, higher rates of fraud, and ultimately higher overall costs and worse outcomes for patients. Her organization does not support making permanent any payment parity requirements for Medicare and urges policymakers to focus on a telehealth value-based payment system.
Dr. Mahoney pointed out that the perception that telehealth may be overused and lead to increased healthcare costs has not become reality. Instead, Dr. Mahoney alluded to telehealth as another tool in the toolkit and is largely substitutive as opposed to in-person care. Today, 30-40% of Stanford Clinics visits are conducted via telehealth. She also urged policymakers to recognize that video visits and in-person visits require the same effort that medical decision-making by providers and should be reimbursed equally.
With recent concerns raised over the potential for increased fraud, abuse, or misuse of healthcare services with enhanced convenience of care, the HHS Office of Inspector General reports, that the Office is conducting significant oversight work and is assessing telehealth services during the public health emergency, including activities related to fraud, abuse, and misuse.
In a recent update from HHS, the Office commented that they are aware of concerns raised regarding enforcement actions related to telefraud schemes, but that it is important to distinguish those schemes from telehealth fraud.
Of the several large investigations of fraud schemes investigated over the last few years, in many cases, the criminals did not bill for the sham telehealth visits. Rather, perpetrators billed fraudulently for other items of services such as durable medical equipment or genetic tests. It is thought that the results from HHS will likely be a key component to any final decision made by Congress with respect to the permanent expansion of telehealth coverage and payment parity.
For more information, ask questions, provide feedback, or provide news, email Jailendra Singh at jailendra.singh@credit-suisse.com or call 212-325-8121.