In a Senate hearing held on June 17, Senators discussed the possibility of extending the emergency telehealth protocols once the coronavirus pandemic has passed. The Senate HELP Committee Chairman Sen. Lamar Alexander was particularly vocal on the originating site rule and the expansion of telehealth reimbursement.
“Our job should be to ensure that change is done with the goals of better outcomes and better patient experiences at a lower cost,” said Alexander.
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Senate HELP Committee: Telehealth Issues
During the Senate HELP Committee hearing, Congress assessed the benefits of telehealth as well as the barriers to the continued use of telehealth. Private-sector patients, those patients covered by their employer’s health insurance plan, showed several areas in need of improvement.
◈ Geographic Location: there are interstate medical licensing compacts that expand the network of available providers, allowing providers to treat patients in other states. However, many states have failed to join, limiting access as providers can only treat patients residing in their state. This requirement has been temporarily waived for Medicare, but has not been extended to private sector patients.
◈ Unnecessary Telemedicine Barriers: there are several barriers to telemedicine that impede patients ability to seek virtual care. These include:
◆ Requiring that a patient travel to a specific telehealth site before they can connect to a provider
◆ Limiting telehealth to specific technologies (for instance, requiring two-way video which may be out of reach by those in rural or other areas without broadband access)
◆ Mandating that a patient can only do a telehealth visit with a doctor they already have a relationship with
◈ Federal Government Regulations: telehealth cannot be offered to employees that are not enrolled in the company’s full medical plan. This prevents access to telehealth for the following workers:
◆ Full-time employees who are not enrolled in the medical plan, or employees’ family members, if the employee is on a self-only plan;
◆ Part-time employees ineligible for the medical benefit;
◆ Seasonal, agricultural, or other temporary workers;
◆ Interns, trainees, and the like; and
◆ New employees on a waiting period for the full medical plan, among others.
Senate HELP Committee: Key Steps to Improve Telehealth
To improve access to telehealth, legislation surrounding its use must be passed. Recommendations have been made to the Senate HELP Committee for improved access.
◈ Practicing Across State Lines: to allow providers to practice across state lines, Congress can pursue two avenues. The first option is requiring states to recognize medical licenses from other states for the purpose of providing telehealth to patients residing outside of the state the provider is licensed in. The second option is to revise the comprehensive interstate compact so that it includes incentives for states to join.
◈ Implementing Simple Federal Standards: generally, state governments regulate medical standards for their state. However, telehealth standards should transcend geographic boundaries and instead be regulated federally. These standards should:
◆ Allow telehealth to establish a patient-provider relationship through an initial telehealth visit;
◆ Apply the same medical standard of care used for in-person to telehealth visits;
◆ Ensure that reimbursement is privately negotiated between providers and payers;
◆ Encourage interstate practice among providers;
◆ Promote continuity of care by encouraging telehealth providers to coordinate with a patient’s primary care provider;
◆ Implement “technology-neutral” rules for telehealth, to “future-proof” rules for advances in technology and best practices, and eliminate discrimination for patients who may not have access to broadband internet;
◆ Eliminate all “originating site” requirements that arbitrarily limit patient access to telehealth;
◆ Preserve the same informed consent requirements for patients in telehealth that apply in person; and
◆ Ensure that telehealth providers may prescribe medication to patients, with reasonable limits.
◈ Designating Standalone Telehealth: there are already other health benefits that are treated as a standalone, as in not part of a full medical plan. Congress can pass legislation allowing telehealth to be considered a standalone offering much like vision, dental, and long-term care.
To read more about the lessons learned from telehealth, please click here.
