March 5, 2021
House Energy & Commerce hearing on the future of telehealth
On Tuesday (March 2), the House Energy and Commerce Subcommittee on Health held a hearing entitled "The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care." There was broad bipartisan support on the committee for continuing various flexibilities advanced during the pandemic period around telehealth, with many noting that telehealth has been a bright spot and silver lining of the pandemic. Several committee members focused on the need to ensure appropriate access to telehealth in rural areas, where broadband access is often lacking, to "bridge the digital divide" in order to advance equitable access to care, and others expressed the particular promise in the area of mental and behavioral health care. While there was some concern over the potential for overutilization, fraud, waste and abuse, the committee was largely supportive of continued access to flexibilities and the main question was surrounding which areas to focus. Near the end of the meeting, Subcommittee Chairwoman Anna Eshoo (D-CA) noted that, "we have some work to do to make sure no one falls through the cracks."
The witnesses were also largely in agreement with the need to continue access to telehealth flexibilities while ensuring access does not exacerbate existing disparities, and there was broad support for the use of telemedicine to increase access to mental health professionals in particular. There was also some agreement that shifting away from fee-for-service and towards value-based health care would enable them to adopt more of these solutions. There was, however, disagreement over appropriate payment, changes to licensure, and overutilization concerns. While Dr. Ateev Mehrotra of Harvard Medical School said telehealth has lower overhead and should thus be lower payment, Dr. Resneck from the American Medical Association said that providers have invested significantly in infrastructure to support telehealth and they should still be paid based on the time spent with the patient as well as their complexity. Ms. Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health added that payment using RVUs are not appropriate due to the ability for providers to see more patients quicker when using telehealth.
While there was some support for the TREAT Act, which would provide temporary licensing reciprocity for telehealth and interstate health care treatment, Dr. Resneck noted that federal licensure is not ideal and that instead he believes efforts should be made to increase membership in the Interstate Medical Licensure Compact (IMLC). Dr. Mehrotra, on the other hand, said that he would go beyond the TREAT Act and noted issues with interstate medical compacts due to complexity and cost. Regarding the concerns around overutilization, Dr. Megan Mahoney of Stanford Health Care said that they have found telehealth to be largely substantive, not additive, while Dr. Mehrotra said that there was some evidence of overutilization in the pre-pandemic period, although more data is needed. A call for more data collection on utilization, outcomes, and disparities was supported throughout the hearing, and Dr. Mehrotra suggested a one- to two- year continuation of flexibilities to allow for this.
From a beneficiary perspective, Mr. Frederic Riccardi from the Medicare Rights Center said throughout the hearing that they must provide payment for audio-only services, as it has been a lifeline both for those who don't have broadband as well as for those with connectivity issues or disabilities, which was also supported by Dr. Resneck. Mr. Riccardi also noted that cost-sharing should be the same regardless of how services are provided.
Hearing information is available here.
Additional details can be found in the attached Tax Alert.
Future of telehealth