Congress is once again closing in on a deadline to extend Medicare coverage of home telehealth services. And, again, the decision has been left until the last minute.
Telehealth has had new flexibilities since the Covid-19 public health emergency began, including expanded Medicare reimbursement. Originally scheduled to sunset alongside the emergency’s declared end, these flexibilities have been extended over and over again, often just weeks before planned expirations hit.
Congress has seen several bipartisan bills ranging from another extension to even making some Medicare flexibilities for telehealth permanent. The House included an extension in a stopgap bill that aimed to avoid a looming government shutdown, but the Senate rejected it last week.
If nothing is passed, on Oct. 1, many Medicare members won’t be able to access telemedicine from their homes anymore.
Even if an extension is passed, this uncertainty still impacts providers’ businesses, leaving them struggling to plan for a potential future where they might lose a chunk of their patients, experts told us.
“For us in the industry, it creates operational and administrative burdens to ensure we are compliant. For patients, the uncertainty creates a lack of trust,” Taya Gordon, CEO of Atlas and Perpetua Healthcare Consulting and government affairs committee member for the professional organization Medical Group Management Association (MGMA), said.
The deets. If the flexibilities go away, most Medicare patients will have to take telehealth appointments from a provider’s office, hospital, or skilled nursing facility. They won’t be able to take calls from home unless they’re getting treatment for mental health or a substance use disorder, or a few other narrow exceptions.
Other restrictions will also come back into play. Telehealth will once again be limited to patients in a rural health professional shortage area, within a federal telehealth demonstration project, or in a county that isn’t in a metropolitan statistical area.
Each time these flexibilities get close to expiring, medical groups must plan how to transition telehealth appointments to in-person appointments and budget for the cost of losing some patients, Anders Gilberg, SVP of government affairs for MGMA, told Healthcare Brew over email.
Amid this repeated “headache,” some providers are “seriously thinking about eliminating” telehealth and remote patient monitoring, Tom Leary, SVP and head of government relations of the Healthcare Information and Management Systems Society, told us.
Commitment issues. The end of telehealth flexibilities would also affect a lot of people.
The percent of eligible Medicare beneficiaries getting telehealth services skyrocketed from 6.9% in Q1 2020 to 46.7% the following quarter. It fell after that, but is still higher than pre-pandemic: In Q4 2023, 12.7% received telehealth care, according to KFF data.
If the flexibilities expire, the rules will largely revert to how they were in March 2020. Those rules existed in a world where there was insufficient data on telehealth outcomes, but over the last five years, telehealth has been proven worthy of broad Medicare coverage, Leary argued.
A 2024 review in the Cureus Journal of Medical Science found telehealth can improve patient health and save costs while helping patients overcome geographic barriers to care.
“There was [previously] not enough data on telehealth use by Medicare patients to be able to properly do the actuarial work,” Leary said. “That argument is no longer valid.”
This report was originally published by Healthcare Brew.
