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Expansion of Telehealth Policies Gain Support in Senate HELP Hearing

June 19, 2020

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Jason Kleinman, Senior Legislative Analyst, Govt. Relations

The Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on June 17 to explore telehealth policy changes and examine lessons learned from the rapid shift from in-person health care visits to telehealth in response to the COVID-19 pandemic. Senators and witnesses, including leaders in telehealth innovations at AAMC member academic medical centers, highlighted the increased reliance on telehealth during the current pandemic and urged Congress to permanently expand access to telehealth beyond the public health emergency.

In his opening statement, Committee Chair Lamar Alexander (R-Tenn.) said, “As dark as this pandemic event has been, it creates an opportunity to learn from and act upon these three months of intensive telehealth experiences, specifically what permanent changes need to be made in federal and state policies.”

Chairman Alexander recommended policy changes such as reimbursing physicians for a telehealth appointment wherever the patient is located, including in their own home. He also recommended that Medicare and Medicaid permanently extend a policy change that reimburses providers for nearly twice as many types of telehealth services.

Several witnesses also called on Congress to permanently extend recent changes to telehealth policy that were included in the first two COVID-19 supplemental funding packages [see Washington Highlights, March 6 and March 20].

During her testimony, University of Virginia Karen S. Rheuban Center for Telehealth Director Karen Rheuban, MD, told the committee that studies over the past two decades have proven the benefits of telehealth, and the pandemic has demonstrated its full potential. It is, she said, time to make full use of telehealth in the delivery of health care services.

“The simplest and most important step would be for Congress to give the Secretary the authority to make permanent the telehealth changes made during the public health emergency,” Rheuban said.

American Telemedicine Association President and Harvard Medical School professor Joseph Kvedar, MD, highlighted the recent surge in telehealth usage in his testimony.

“Mass General Brigham providers will go from approximately 1,500 virtual visits per month to 250,000. Pre-pandemic, only .2% of all ambulatory outpatient visits were conducted via telehealth. Now, we anticipate 60% of ambulatory care will be delivered remotely,” Kvedar said.

Kvedar also pointed out the importance of addressing the current statutory restrictions on patient geography and originating site limitations. Additionally, he recommended that the Secretary of the Department of Health and Human Services “has the flexibility to expand the list of eligible practitioners and therapy services, and, similarly, maintain the authority to add or remove specific telehealth services, as supported by data, to make certain all eligible services are safe, effective, and clinically appropriate.”

Sanjeev Arora, MD, the founder and director of Project ECHO and a distinguished and regents’ professor at the University of New Mexico Health Sciences Center, said in his statement that telehealth can play a major role in enabling patients to get the care they need, when they need it, in or near the places where they live.

“Project ECHO is a model for telementoring or what’s now called technology-enabled collaborative learning and capacity-building model,” Arora explained. “Essentially, models like ECHO leverage technology, including videoconference platforms such as Zoom, to ensure that clinicians on the ground have the latest best practices, mentoring and support they need to treat patients in their communities.” Project ECHO addresses 75 different health conditions across 48 states, and there are ECHO projects at more than 250 organizations across the country, including at AAMC member academic medical centers.

Arora urged the committee to support policies included in the House-passed Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (H.R. 6800) that would create a grant program under the Health Resources and Services Administration “to support organizations that are using technology-enabled collaborative learning and capacity-building for COVID-19 response.”

Earlier in the week, Sens. Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.) led a bipartisan letter signed by 30 senators that calls on Senate leadership to permanently expand access to telehealth services that have been made available during the COVID-19 pandemic.

The letter states, “Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic. Doing so would assure patients that their care will not be interrupted when the pandemic ends. It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.”

The AAMC previously sent a letter to Centers for Medicare & and Medicaid Services Administrator Seema Verma urging the administration and Congress to make permanent some of the telehealth waivers and flexibilities that have been put in place during the public health emergency [see Washington Highlights, May 15.]

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