WILMINGTON, MA – MARCH 15: Erica Jensen, with her 5-month-old daughter, Charlee Jaques, by her side, … [+]
Telehealth will end on December 31 unless Congress takes urgent action to pass the Telehealth Moderniztion Act of 2024.
Before COVID, Medicare provided limited coverage for telehealth and mainly limited it to rural patients. It required them to go to a local hospital or clinic to interact with a specialist until early 2020. At the beginning of the COVID-19 pandemic, Medicare greatly expanded coverage to include patients anywhere, allowing them to access specialty care from home. Expanded services also included physical and occupational therapy, emergency department visits, and nursing facility care via telehealth. This expansion provided care to Medicare’s 64 million enrollees and broadened pre-existing access for 76 million low-income Americans on Medicaid.
It’s not just patients on Medicare/Medicaid who need to worry if this bill isn’t renewed. Private insurers often follow Medicare’s lead regarding what services they will cover.
Congress.gov summarizes the H.R. 7623 Telehealth Modernization Act of 2024 as follows: “This bill modifies requirements relating to coverage of telehealth services under Medicare.
Specifically, the bill permanently extends certain flexibilities that were initially authorized during the public health emergency relating to COVID-19. Among other things, the bill allows (1) rural health clinics and federally qualified health centers to serve as the distant site (i.e., the location of the health care practitioner); (2) the home of a beneficiary to serve as the originating site (i.e., the location of the beneficiary) for all services (rather than for only certain services); and (3) all types of practitioners to furnish telehealth services, as determined by the Centers for Medicare & Medicaid Services.”
Why Does Telehealth Matter?
Being able to access medical remotely has been a huge boon to many, particularly in rural areas or those who are disabled.
Jessica Offir, PhD, is a disabled health care advocate and social psychologist for whom telemedicine is a priority issue. She observed that a stumbling block to the renewal of the bill is that “insurance companies didn’t want to pay the same amounts as they were for in-person care, but providers have been insisting on it.” She added, “Trump is also wanting to reduce Medicare & Medicaid payouts, and this is one way to make that happen, as telehealth greatly increased the healthcare access of the elderly and disabled. Take away access, and payments decrease. The only entities who benefit are insurers.”
My own family are ardent supporters of access to telemedicine. We live in western Maryland, a three-hour drive to the university hospitals in Washington/Baltimore. I’m unable to drive that far, so increasingly rely on remote services, particularly for specialties that are poorly represented in our town. If telemedicine services are cut, I will be unable to access some specialties I need. Someone drives me twice a year for in-person examinations. These increasingly feel hazardous to my health for two reasons—one is the worsening traffic and trucking on the interstate. The other is that while my family still recognizes that the COVID-19 pandemic has not ended, our providers have not. They have stopped masking and even turned off HEPA filters in exam areas and waiting rooms, leaving them abandoned and useless. I take an Aranet CO2 monitor with me everywhere and try to educate people. On one recent visit, the CO2 level went from 600 ppm when I entered the exam room, to 1704 ppm before I left! That’s a level that can make you sleepy and show poorer judgment. I explained to the physician that each breath that he took had 3.4% rebreathed air from someone else, per SN Rudnick and Don Milton’s study, popularized by David Elfstrom’s reference table. That caught his attention and recognition of his potential risk of a Covid or other respiratory tract infection.
My experience is not unique. A recent article found that more than 17 percent of older Medicare beneficiaries similarly report difficulty traveling to doctor’s offices. Those over 65 averaged about 17 contact days that year for ambulatory care. That rose to 30 contact days per year for the 14 percent of patients with ten or more chronic illnesses—a considerable time and energy burden.
Another study of cancer patients found (73.8%) rated their first telemedicine visit as good as or better than an in-person visit, and 4606 (18.9%) rated it superior. In another striking example, those who received care through telehealth with peer assistance were almost seven times more likely to be treated for hepatitis C and four times more likely to achieve viral clearance after six months.
One bit of good news is that on November 15, the U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) announced they will extend telemedicine flexibilities through 2025. This is an important win for access to medication in end-of-life care. More than 40,000 comments were submitted to the DEA.
Paying for telehealth is a major concern now, although there has been bipartisan support for the bill. A House Republican staffer explained that “Medicare beneficiaries are on a cliff, losing tele services after December 31 2024.” Congress is negotiating how long another extension could look like and where the funding will come from, with the two parties not yet in agreement.
There have been higher per-person costs where more telehealth is used. On the other hand, telemedicine might improve patient compliance with medications and reduce costly emergency room visits.
One can argue about relative costs, but the bottom line is that there are people behind these numbers—largely disabled, elderly and rural. There are some concerns about ensuring quality of care, but that appears to be minor.
The Action Network is encouraging people to write their Congressional representatives to urge them to pass this Telehealth Modernization Act before the end of the year. It’s the only chance of saving it. With the news of planned slashes to government spending, there is no time to waste.
As Offir reminds us, “Once again, the people who will be most harmed are the vulnerable populations that can least afford to be.”
You can contact your House representatives here, and Senators here.
Note: I reached out to the offices of a number of co-sponsors of the bill to ask what obstacles remain without response except from one House Republican’s office.
