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Why virtual care will outlast the pandemic

With millions of people suddenly video chatting their doctors, there's pressure on Washington to make telehealth a permanent option.

Published Tuesday, June 16, 2020

An explosion of virtual care during the pandemic is raising expectations that Washington will make sure Americans can continue video chatting with their doctors after the health crisis subsides.

Telehealth had been inching ahead for quite a few years, but it remained a niche industry amid a thicket of regulatory restrictions designed to combat potential fraud and high costs. That was until the pandemic hit and the Trump administration swiftly — though temporarily — knocked down many of those barriers, with states and private health insurers also expanding coverage of virtual care.

Millions of people have turned to telehealth amid stay-at-home orders, including many who would otherwise struggle to access health care. Advocates for the technology are now making an all-out push to cement a permanent role for telehealth, warning that a rapid retrenchment could devastate patients while the coronavirus is still spreading.

“Telehealth has rapidly transformed from a technocratic, wonky issue to an essential strategy for keeping people alive,” said Sen. Brian Schatz (D-Hawaii), one of the technology’s biggest boosters on the Hill. “We’re going to realize that all the changes we enacted ought to be permanent.”

Since Covid-19 emerged, telehealth visits for Medicare seniors soared from a few thousand per week to just over 1.3 million. Virtual therapy sessions at a prominent telehealth company have more than doubled. Providers said fewer low-income patients missed appointments at safety net clinics across the country — from rural New Mexico to urban parts of Maryland — since they could more easily video chat their doctor without having to arrange transportation or childcare.

Those early results from America’s surprise crash course in telehealth suggest that patients have quickly adjusted to remote care. That’s left advocates cautiously optimistic the past few months have built the long-term case for virtual care.

But telehealth advocates will have to win over skeptics in Congress, as well as in the Medicare agency itself, who have worried that telehealth is a ripe target for fraudsters or could drive up America’s massive health care tab by encouraging overuse of services. Little data has emerged so far on the broader impact of telehealth's upswing, but advocates are eager to seize on the moment.

A bipartisan pair of House dealmakers, Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.), are pushing to include telehealth provisions in an upcoming coronavirus relief bill and medical innovation legislation next year, they said at a POLITICO event on Thursday. The pandemic has sparked a wave of new telehealth bills, including a measure to permanently expand Medicare payments for safety-net clinics.

The Senate health committee is holding a hearing next week on telehealth’s pandemic-related boom. And President Donald Trump’s Medicare chief, Seema Verma, recently declared telehealth is here to stay, though she said federal officials would likely have to tighten some measures without new permission from Congress.

“I just can’t imagine going back because people recognize the value of this,” Verma said at an event hosted by Stat News this week.

Medicare used emergency powers to lift restrictions that generally limited telehealth payments to rural providers and doctors with existing relationships with patients. It also waived a strict requirement that barred payments for regular phone calls, a policy that limited access for poorer and rural patients without broadband internet and expanded telehealth services to more health care settings like nursing homes and hospices. Strict privacy rules on video chat apps were also relaxed, allowing health care providers to now use FaceTime and Google Hangouts rather than invest in expensive technology platforms.

Taking Medicare’s cue, state Medicaid programs and private health insurers also relaxed stricter policies on virtual care. Private health insurance claims for services jumped 4,300 percent in March 2020 compared to the previous year, according to new data from a massive trove of claims data held by the nonprofit Fair Health.