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  • Washington Highlights

    Senate Finance Committee Discusses Telehealth, Other COVID-19 Flexibilities


    Jason Kleinman, Senior Legislative Analyst, Govt. Relations

    The Senate Finance Committee held a hearing on May 19 titled, “COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned.” The hearing predominately focused on the current waivers and flexibilities related to telehealth, as well as the Hospital Without Walls and Acute Hospital Care at Home waivers, which many committee members commented have all expanded access to care during the current pandemic.

    The AAMC submitted a statement for the record urging Congress to extend several of the temporary telehealth waivers. The statement urges Congress to:

    • Allow patients to access telehealth services from any location.
    • Reimburse providers the same amount for telehealth services as in-person visits.
    • Allow Medicare payment for audio-only services.
    • Allow patients to access telehealth services across state lines as appropriate.
    • Allow for virtual supervision of residents by teaching physicians.
    • Allow “authorized practitioners” to prescribe buprenorphine via telehealth.
    • Improve access to broadband technology.

    Additionally, the AAMC called on Congress to eliminate the skilled nursing facility three-day prior hospitalization requirement, expand the delivery of inpatient care in patients’ homes through the Hospital Without Walls program, and consolidate all health-related waivers under the authority of the Health and Human Services Secretary.

    In his opening statement, Chairman Ron Wyden (D-Ore.) stated, “This morning’s hearing is an opportunity to talk about the changes that ought to stick around post-pandemic, and there’s no better example than telehealth.” He added, “The telehealth challenge has always been about balancing the speed and efficiency of new technologies with the need for health care quality and accountability…My view is, as a general proposition, patients ought to have telehealth available as an option after seeing a provider for the first time.” Chairman Wyden also highlighted the bipartisan support for a provision in the Consolidated Appropriations Act, 2021 (P.L. 116-260) that “allowed all seniors in Medicare to receive mental health services via telehealth, including at home. My view is, mental health services ought to be available via telehealth for all Americans.”

    Ranking Member Mike Crapo (R-Idaho) noted his support for telehealth in his opening statement, stating, “Telehealth has been a lifeline for patients and providers, especially in the early months of the pandemic. The reliance on telehealth increased in rural and urban areas alike, allowing patients to receive remote care from the safety of their home.” He continued, “To ensure financial stability, providers have been paid at the same rate as if the service was furnished in-person. This has facilitated care that otherwise would be risky or unavailable, and patients have appreciated the convenience. It has reduced the frequency of missed appointments, and assisted provider investment in the infrastructure needed for remote care...The promise of telehealth is clear, but it is important that we gather evidence on its impact on access, quality, and cost.”

    In her testimony, Jessica Farb, director, Health Care, U.S. Government Accountability Office (GAO), highlighted that the Medicare telehealth waivers have increased utilization of telehealth services. The GAO testimony notes, “Available analysis from the CMS Accomplishment Report indicates that over the first eight months of the pandemic, utilization of telehealth services in Medicare FFS sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late-April. Utilization then dropped to about 1.3 million services by the beginning of June, and generally continued to slowly drop through mid-October.” She added, “The long-term effect of these waivers on spending and quality of care is not yet known.”

    Linda DeCherrie, MD, clinical director, Mt. Sinai At Home and Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mt. Sinai, highlighted her support of the Hospital at Home and Acute Hospital Care at Home waivers that allow hospitals to provide care at home to certain patients. She noted, “Having a payment model for Hospital at Home/Acute Hospital Care at Home is needed to serve Medicare beneficiaries beyond the pandemic and especially if an emergency of this type ever happens again.” She added, “We request Congress and HHS to consider a permanent extension of the Hospital Without Walls and Acute Hospital Care at Home waivers beyond the PHE to mitigate the residual impacts of COVID-19 on public health and encourage broader adoption of providing patient centered health care services in the home.”

    During the hearing, many members of the Committee from both parties noted their support for extending the waivers that allow Medicare beneficiaries to receive telehealth services from any location and to access telehealth through audio-only services beyond the end of the public health emergency. Kisha Davis, MD, member, Commission on Federal and State Policy, American Academy of Family Physicians, mentioned that it is easier to integrate translation services for patients with limited English proficiency into telephone visits since audio-video platforms can be costly and complex.

    Dr. Davis also stated, “While the rapid expansion of telehealth has yielded many benefits for patients and clinicians, not everyone has benefited equally.” She suggested that any data collection and reporting on telehealth to inform the direction of permanent telehealth policies be stratified by race, ethnicity, gender, language, and other key factors to ensure that these policies don’t inadvertently worsen health disparities.

    In response to a question from Sen. Chuck Grassley (R-Iowa) about which flexibilities Congress should consider to improve patient access and remove federal red tape, Davis stated, “By allowing physicians to provide direct supervision and teaching services via real time two-way audio-video communication, we could expand access to primary care and increase training opportunities.”

    Sen. Steve Daines (R-Mt.) voiced his support for telehealth, adding, “I believe we need to do what we can to make expanded access to telehealth permanent.” He asked the witnesses how important payment parity is to ensure access to care. Executive Director and Board Member of America’s Physician Groups Narayana Murayali, MD, responded, “There’s a lot of investment that goes into the infrastructure to maintain the ability to provide telehealth and actually lower the costs of care. So, payment parity is absolutely important from that standpoint.”

    Sens. Sheldon Whitehouse (D-R.I.) and Mark Warner (D-Va.) both mentioned the important role of telehealth in mental and behavioral health. Whitehouse noted, “The medication assistance treatment element and allowing access to buprenorphine, for instance, with telehealth has been a godsend for that population.”