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Featured topic and speakers
What is the forecast for telemedicine? What are the threats to telehealth? Do doctors like telemedicine? What telehealth services are covered by Medicare?
Our guest is Dana Lichtenberg, assistant director for Congressional Affairs at the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Dana Lichtenberg, assistant director, Congressional Affairs, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about the work that's happening at the federal level to fight for the future of telehealth access. Our guest today is Dana Lichtenberg, assistant director for Congressional Affairs at the AMA in Washington, DC. And I'm Todd Unger, AMA's chief experience officer in Chicago. Dana, welcome.
Lichtenberg: Thanks. Great to be here.
Unger: Well, as we all know, telehealth grew immensely during the pandemic. And of course, this was made possible by federal legislation that was passed in March of 2020. I don't really like thinking about March of 2020. I try not to do it. But we're going to start there, with a little bit of background from you on exactly what that legislation was and what it did.
Lichtenberg: Well, we'll start with the statute. Under a very old Medicare law, telehealth services can only go to a rural patient, and you have to go into a health care facility in order to receive it, which makes absolutely no sense. The law predates the internet. It predates cell phones. It is a remnant.
When COVID hit, as part of the COVID relief bill, Congress lifted those restrictions so that all Medicare beneficiaries now have access to telehealth services that are covered and paid for by Medicare. Congress acted again in 2022 to extend those flexibilities for two years, and that's where we are today.
Unger: It's hard to believe that's kind of before remote work and Teams and Zoom and all of that kind of stuff, the kind of assumptions in there. Well, ever since that time, the AMA has been working to make those telehealth flexibilities permanent. How has that been going?
Lichtenberg: It's been going very well. Telehealth is extremely popular. It has become part and parcel of medicine. Most members of Congress have had a telehealth visit in the last five years. So it's all patients and most physicians are using it.
They may work directly with Congress to help them draft legislation that became the basis of both waiver extensions. We wanted to make sure that they did exactly what they needed to do, and they didn't have any extra things that they didn't need to do—for example, putting in-person requirements on tele-mental health services or reporting requirements that were unnecessary.
Unger: That's great. And even recently as May, the Ways and Means Committee unanimously passed a bill that would extend that expiring telehealth flexibility for another couple of years. Any other kind of major milestones that are happening?
Lichtenberg: Yes. Since then, the Energy and Commerce Health Subcommittee has passed a virtually identical bill that did include a couple additional items. For example, it authorized Medicare to do a virtual diabetes prevention program. So we are very excited about the path that those two bills are going on. We expect the Finance Committee, which is on the Senate side, will act on similar legislation in September.
Unger: Can you just remind everyone why it's so important that these telehealth flexibilities are made permanent?
Lichtenberg: If Congress does not act before the end of this year, Medicare will not be able to cover and pay for telehealth services unless you live in a rural area. No one wants to see this happen. So telehealth has become part and parcel of the practice of medicine. Patients expect it, physicians expect it, and it's had an overall impact—a positive impact on the health care system.
Unger: Well, thankfully, there is legislation on the table that could provide a long-term solution here. What can you tell us about that and where it stands currently?
Lichtenberg: Unfortunately, the holdup has been cost. So the Congressional Budget Office has scored the two-year extension as costing $2 billion per year because it increases the number of Medicare services that will be used. So that is the primary reason that nothing has happened up to this date. It's costly.
Will Congress allow telehealth to expire? We have absolutely zero expectations that that will happen. Congress will act at the end of the year to pass a two-year extension of the current telehealth authorities. The question is, moving forward, can we get the data to the Congressional Budget Office to show the positive impact that telehealth is happening on the health care system and on patient outcomes?
We know for a fact, based on our own research, that there are savings to be had. Telehealth reduces ER visits, for example. And we've seen that in our own research. We've seen that in research of other actors in the health care system. We know it improves patient outcomes. For example, it can be very effective in delivering services to help patients self-manage their A1C and blood pressure. And those things are measurable. So the goal here is to work with the coalitions that we've developed in DC and Congress to get the data together that we can get to the Congressional Budget Office to lower the score so that we can do what is the practical thing to do, which is make it permanent. There's no reason for the restrictions in the first place.
Unger: And that makes sense and that's something that the advocacy team is very good at, is getting that data and presenting that, of course, to Congress and all the affiliated parties there. If you're a practicing physician, health system out there, and you're thinking about investing in your telehealth solutions, what do you do in the meantime, given that kind of uncertainty?
Lichtenberg: 99.9% sure that Congress will do the two-year extension, and I am 99.9% sure that eventually we will get to a permanent solution. I think the problem is that it may be an extender for a while, meaning that every two years Congress acts to extend it again. That will become costly over time. Telehealth is part of the Medicare package now. Medicare continues to extend the number of services that can be provided virtually. So at some point, there'll be a tipping point. We'll have enough data to show that, yes indeed, this doesn't increase costs. And then we go from there. But for right now, I feel very confident that Congress will act. We have heard absolutely nothing in DC that would indicate otherwise.
Unger: Well, that's positive news. And Dana, I just want to recognize you and the advocacy team for the work that was done in the first place to get all of this in motion. Of course, telehealth has become such an important tool for health care for both physicians and patients at this point. So thanks for joining us today and giving us this important update.
For all of you out there who think things like advocacy on telehealth is really important, we encourage you to become an AMA member at ama-assn.org/join. That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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