COVID-19 has led to dramatic increases in adoption of telehealth by both physicians and patients. Policymakers should seize the opportunity to make permanent policy that supports many of these advancements beyond the pandemic.
Why telehealth is important
In the March 15, 2022, episode of Moving Medicine, AMA Chief Experience Officer Todd Unger discusses the importance of protecting the future of telehealth with Jason Marino, AMA director of Congressional Affairs.
Early on in the COVID-19 pandemic, with strong support of the AMA, the restrictions on coverage for telehealth services were lifted by Medicare and other health plans.
Unfortunately, many of the telehealth flexibilities that have greatly improved patient access to care throughout the pandemic are set to expire five months after the end of the national public health emergency. In a survey (PDF) conducted by the AMA on telehealth usage, nearly 70% of physician respondents reported an interest in continuing to provide telehealth services. However, much of this continued use and expansion of services will not be possible with a return to the previous lack of insurance coverage and payer reimbursement.
Achieving permanent Medicare coverage of telehealth services for patients, including allowing them to continue receiving these services in their homes, is important for patient access to care. The AMA is working to ensure (PDF) physicians have the tools, resources and support to seamlessly integrate telehealth into their practices without financial risk or penalty.
Federal work on telehealth policy
Prior to March 2020, the Medicare program only paid for telehealth services in very limited circumstances:
- Patients had to reside in rural areas
- Patients could only receive telehealth services at a medical facility
- Two-way audio-video telecommunications equipment had to be used
- A limited number of services were on the Medicare Telehealth List
- Because payments were at facility rates, they were about 30% below in-office payment rates
During the nationwide COVID-19 Public Health Emergency (PHE), the AMA successfully advocated for Medicare to pay for telehealth:
- In rural and non-rural areas all over the country
- To patients in their homes or wherever they are located without the need to go to a medical facility
- From physicians providing telehealth services from home or wherever they are located
- Using audio-video telecommunications equipment, smartphones or audio-only telephones including landlines
- At the same rates as in-person physician office services
- For a greatly expanded number of codes, including telephone visits, emergency department visits, home visits, hospital-at-home services and many types of therapy
The AMA also strongly supports a law enacted in March 2022 that will extend many of the telehealth policies that were put in place for the PHE for an additional five months after the PHE ends.
The biggest challenge now is to get legislation enacted that will permanently lift the rural-only and originating site restrictions (PDF) on telehealth coverage for Medicare patients.
- The Telehealth Modernization Act of 2021 would lift the rural-only restriction and add any site where a patient is located as a potential originating site.
- The CONNECT for Health Act would lift the rural-only restriction, add the home as an originating site, establish a process for the Secretary of the U.S. Department of Health and Human Services (HHS) to add originating sites and provide HHS with the permanent authority to waive section 1834(m) restrictions.
- The Telemental Health Care Access Act is a bipartisan bill that would repeal a new requirement that a patient must see a provider in person within six months of receiving a mental health telehealth service.
State work on telehealth policy
The AMA provides state-level policy guidance and recommendations to expand coverage, access and payment of telehealth services.
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On the state level, the AMA has been working to:
- Support coverage and payment of telehealth
- Require insurers to allow all contracted physicians to provide care via telehealth
- Support hybrid models of care where physicians utilize both telehealth and in-person care
- Eliminate separate telehealth networks as well as policies that steer patients to select telehealth providers instead of their regular physicians
- Prevent plans from using telehealth to meet network adequacy requirements
Additionally, the AMA supported the adoption of “The Appropriate Use of Telemedicine Technologies in the Practice of Medicine” by the Federation of State Medical Boards as an update to their 2014 guidelines. The new document provides guidance to state medical boards on the use of telemedicine in the health care setting and can serve as a model policy for the permanent adoption of telemedicine at the state level.
Equity in telehealth
The AMA has created an issue brief (PDF) outlining specific policy proposals to take significant and necessary steps toward promoting and ensuring equity in telehealth.
State and federal correspondence
- Comment letter (PDF) to the Federation of State Medical Boards supporting their updated Telemedicine Policy.
- Sign-on letter (PDF) successfully urging congressional leaders to extend telehealth flexibilities for five months after the end of the national public health emergency.
- Statement for the record (PDF) to the U.S. House of Representatives Ways and Means Subcommittee on Health supporting continued access to telehealth services for Medicare beneficiaries.
Webinar on telehealth policy
AMA Advocacy Insights webinar series: The future of telemedicine
To address the dramatic increase in telemedicine use as a result of the COVID-19 pandemic, the Federation of State Medical Boards (FSMB) House of Delegates recently updated and adopted “The Appropriate Use of Telemedicine Technologies in the Practice of Medicine.” During this AMA Advocacy Insights webinar, experts from the FSMB provide an overview of the updated policy, discuss current state licensure laws regarding telemedicine and outline continued solutions that can be implemented moving forward.
