With the right legal and policy backdrop, digital health tools will play a bigger and bigger role in healthcare. They offer a huge opportunity to improve patient care, reduce hospitalizations, ease burdens on the healthcare workforce, and better patient engagement—all while helping controlcosts. The Connected Health Initiative is continually looking for ways to ensure that patients and providers can use the right digital tools for the job. For that to happen, we need Congress to recognize the importance of digital medicine and telehealth tools, and address provisions that hinder their use. This is part of a series outlining key priorities for the 118th Congress in legislating on digital health.
Under current law, Medicare is generally not able to pay for live audio and video doctor visits. However, Congress recognized the importance of live audio-visual communication for visits during the COVID-19 public health emergency (PHE), implementing a temporary general waiver to the coverage prohibition. Congress extended the waiver to the end of 2024. We applaud policymakers for sidelining these antiquated restrictions, but Congress should permanently remove the barriers to live audio-visual visits for doctors and patients.
Evidence collected during the pandemic shows that access to telehealth has been both equitable and cost effective. In Virginia, Medicaid expenditures on healthcare services slightly decreased overall while telehealth expenditures stabilized toward the end of 2020 at about 6 percent of overall healthcare expenses.[1] Importantly, the effect was more substitutive than additive: the amounts Virginia spent on telehealth services were roughly equal to the drop in in-person visits.[2] The evidence here appears to provide no support whatsoever for arguments that access to telehealth would cause patients and providers to bill for unnecessary services.
The evidence also shows that coverage of telehealth services, including audio-only services, improved equitable access to care. Before the pandemic, Black Medicaid beneficiaries accounted for 22 percent of claims for telehealth visits, but in the most intense months of the pandemic, they accounted for 30 percent of all telehealth claims.[3] This relative increase in utilization weighs against notions that covering these services will only benefit advantaged patients.
Several bipartisan and popular bills from the 117th Congress would accomplish permanent reform along these lines. Examples include the Telehealth Modernization Act of 2021 (H.R. 1332/S. 368, 117th), the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021 (H.R. 2903/S. 1512, 117th), and Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R. 4040, 117th, as introduced). We urge the 118th Congress to advance measures like these with an eye toward providing maximum statutory flexibility for CMS to cover telehealth visits where appropriate.
We know that Members of Congress want to ensure their constituents get the best value and have the best options in their healthcare. That means ensuring Medicare patients can access the same types of care as patients with private insurance. The Connected Health Initiative is here to show the ways Congress can improve the legal and regulatory environment for digital health companies, doctors, patients, and for the country.
