The coronavirus pandemic has taught the United States much about crisis planning. Today, we clearly see the necessity of having a national plan for the next health crisis, including the ability to conduct rapid testing and distribute personal protective equipment to health care providers. We have a new appreciation for the value of virtual education and working from home. And, the urgency of the COVID-19 pandemic has ushered in a new era of telehealth. As longtime telemedicine proponents, we write to urge immediate congressional action that will at long last ensure that it becomes a central feature of the American health care experience.
The pandemic and accompanying relaxation of regulatory barriers has occasioned an explosion in telemedicine use, vaulting it from a niche application to the very center of health care delivery.
These examples reflect the national surge: Providence St. Joseph’s Health scaled its telehealth visits from 70,000 annually to 70,000 weekly. Massachusetts General and Brigham and Women’s hospitals experienced an increase from 1,500 monthly telemedicine visits to 250,000. Blue Cross of Tennessee reports a 50-fold increase in telemedicine claims as compared with the same period last year.
In the midst of the pandemic, tens of millions of Americans have used telemedicine for the first time, and it has been met with overwhelming patient acceptance. A recent poll of Medicare Advantage beneficiaries revealed a 90 percent positive response rate, and 80 percent of respondents indicated their intention to use telehealth for future medical services. Understandably, a service delivered to the comfort of one’s home is preferable to the inconvenience of driving to a clinic and possibly being exposed to illnesses carried by others.
Telemedicine is also a timesaver for health care providers, who can see more patients and provide services more profitably as compared with the delivery of services in traditional brick-and-mortar settings. Making possible the telemedicine surge was the temporary relaxation by the Department of Health and Human Services of regulatory barriers that have long inhibited telemedicine use. The old rules prohibited Medicare reimbursement for telemedicine consultations unless various strict conditions were met.
The services could only originate from “rural” settings, denying the residents of suburban and urban areas telemedicine availability. Now, telemedicine visits can originate from any location in the nation, urban, suburban, or rural. Local doctors’ offices and hospitals can now qualify as “distant sites,” enabling them for the first time to provide telemedicine services. Previously, telemedicine patients would have to leave their homes, drive to a clinic or hospital, and then be connected electronically to a distant specialist. Now, the consultations can originate from any setting, including a patient’s home. Previously, only HIPAA-compatible devices (generally computers in medical settings) could be used for telemedicine consultations. Now, patients and providers can use telephones, smartphones, tablets, and services such as Skype or Zoom for telemedicine consultations.
Telemedicine services have historically been reimbursed under Medicare at far lower rates than in-person visits. Now, telehealth and in-person visits are compensated at comparable rates. Congress has given the secretary of Health and Human Services authority to waive telemedicine reimbursement regulations on a temporary basis, but the waivers will last only so long as the declaration of a national health care emergency remains in effect. Prompt congressional action is now needed so that HHS can make the regulatory waivers permanent.
The relaxation of the Medicare reimbursement rules for telehealth was long overdue. These legacy requirements stem from a time when our communications networks were less robust and network-delivered, high-quality video images were available only in institutional settings such as hospitals.
Today, much of America lives in a broadband-enabled world. High-quality video is now delivered to many homes over dependable networks. While there are gaps in both broadband affordability for less financially fortunate families and broadband availability in many rural areas, there are no technological reasons to continue the strict limitations on Medicare reimbursement for telemedicine services. We have seen the highly positive results for both patients and health care providers of the temporary easing of those requirements. As a matter of urgent business, Congress and HHS should now ensure that telemedicine permanently becomes core to the American health care experience.
Newton N. Minow was chair of the Federal Communications Commission in the Kennedy administration. Rick Boucher was a member of the US House of Representatives for 28 years and chaired the House Energy and Commerce Committee’s Subcommittee on Communications and the Internet. He is honorary chairman of the Internet Innovation Alliance.