MedPAC commissioners hint at telehealth policies that may remain in place after COVID-19

• Members of the Congressional Medicare Payment Advisory Committee agree that Telehealth will remain here, but are concerned about how to improve access without incurring significant costs in the Medicare program.

• The group considered various Medicare guidelines for telemedicine payments that could become permanent after the COVID-19 public health emergency ends in a virtual meeting on Friday. Many telemedicine regulations have been relaxed due to the pandemic, and MedPAC will advise Congress on guidelines to be permanently adopted in the future.

• In general, the Commissioners seem to recognize that, despite a prior lack of acceptance or circumvention of the digital space, there is no going back. However, the government is walking a tightrope between expanding access and the potentially high cost of the flawed program, while also being aware of the potential for fraud and overuse.

The pandemic has dramatically accelerated the uptake of telemedicine services by healthcare consumers, including seniors, who are covered by Medicare.

The use of telemedicine among Medicare members increased at the beginning of the pandemic. Approximately 1.3 million Medicare members received some form of virtual service in the week ended April 18, a staggering increase from the previous month when only 11,000 members received virtual services in the week ended March 7.

Federal regulators have relaxed many payment rules and guidelines for telemedicine to ensure alternative care as the novel coronavirus has temporarily closed facilities or prevented consumers from visiting in person.

The key question for the industry was how regulators and lawmakers can proceed after the public health emergency is over. Most agree that it will be difficult to turn the tide with so many consumers having better access to virtual help.

“Pandora’s box is open. Telemedicine is a key digital health strategy expected in the future by our beneficiaries. How is MedPAC responding at this tipping point? I strongly recommend adopting it,” said Susan Thompson, Commissioner of MedPAC and The Acting CEO of UnityPoint Health said on Friday.

During the meeting, commissioners seemed more willing to allow the flexibility of telemedicine if they had an advanced alternative payment model rather than a paid one. However, there were pressing concerns about equity and access to these services.

Your concerns are not unfounded. Two recent studies at JAMA showed that nearly a quarter of Medicare seniors did not have access to a high-speed computer and a smartphone with a wireless data plan. Inequality is particularly acute among traditionally disadvantaged populations, including people on low incomes and people who live in rural areas.

Some MedPAC commissioners feared that the potential incentives for the use of telemedicine could unwittingly worsen the digital divide and encouraged ongoing research into the impact of such future actions, also focusing on the cost implications.

The commissioners also rejected proposals from staff to stop reporting on audio-only services. The Trump administration has only temporarily extended the payment for phone calls. Providers serving large numbers of Medicare beneficiaries say they saved their lives by providing ongoing care to their patients, especially those who do not have constant access to the high-quality broadband internet access they need for a video visit.

However, the CMS rejected the potential quality differences between audio-only visits and those with a visual component and declined to permanently allow reimbursement of medical fees through audio-only for 2021. This rule is not yet in force. Final and Covered Benefits are subject to change.

Other commissioners expressed concern that expanding access to telemedicine could lead to the overuse of low-value services and this coverage should be reserved for or targeted at high-risk populations with diseases that require constant monitoring such as diabetes.

One thing seemed completely out of the question: Providers are not allowed to use HIPAA-compliant video platforms that go beyond the scope of the emergency. During the public health crisis, providers were not penalized for using more consumer-centric platforms like Skype or FaceTime in place of platforms that violated privacy laws. – safer and more expensive forms such as those sold by Teladoc providers. And Amwell.

Allowing unsecured technology after the crisis appeared to be a moot point, and Commissioner Karen DeSalvo, Google’s health officer, and former HHS official said there was no need to discuss it further.