The $1.7 trillion spending package Congress passed in December included a two-year extension to telemedicine, but it also showed reluctance to make the changes permanent. rice field.

This article was published on Tuesday, January 31, 2023. Kaiser Health News.

To Sarah Jane Tribble

When the COVID-19 pandemic hit, Dr. Corey Siegel was more prepared than most of his colleagues.

Half of Siegel’s patients, many with private insurance and Medicaid, were already using telemedicine by logging into appointments via phone or computer. “You get to see their families and their pets,” Siegel said. “You see more of their lives than when they come to you.”

Siegel’s Medicare patients weren’t eligible for telemedicine until the pandemic forced Congress and regulators to temporarily pay for telehealth as well as in-person care.

Siegel, chief of gastroenterology and hepatology at Dartmouth-Hitchcock Medical Center, is licensed in three states, and many of his Medicare patients make two or three round trips for appointments. I used to drive a lot of time. .

The $1.7 trillion spending package Congress passed in December included two-year extensions to key telemedicine provisions, including coverage for Medicare beneficiaries to receive phone or video consultations at home. rice field. But it also shows politicians’ reluctance to make payment changes permanent, and federal regulators are investigating how Medicare subscribers are using telemedicine. need to do it.

Julia Harris, associate director of health programs at the Washington, D.C.-based Center for Bipartisan Policy think tank, said the federal extension “basically kicked off two years of canned food.” At issue are questions about the value and cost of telemedicine, who benefits from its use, and whether voice and video appointments should continue to be reimbursed at the same rate as in-person care.

Before the pandemic, Medicare only paid for limited uses of telemedicine, such as emergency stroke care provided in hospitals. Medicare also covered telemedicine for patients in rural areas, but not at home. Patients had to be moved to designated locations such as hospitals and clinics.

But the pandemic has caused a “dramatic shift in perception” and telemedicine “has become a common term,” said Kyle Zebray, senior vice president of public policy at the Telemedicine Association of America.

omnibus bill Terms include:: Audio Only and Home Care Payments. Make telemedicine available, including a variety of doctors and occupational therapists. Delay in-person requests for mental health patients. Continue existing telemedicine services for federally accredited clinics and local clinics.

Telemedicine use among Medicare beneficiaries increased from less than 1% pre-pandemic to more than 32% in April 2020. Service Billing Analysis McKinsey & Company

Concerns about the potential for fraud and the cost of expanding telemedicine have put politicians on hold, said Josh LaRosa, vice president of Wynn Health Group, which is focused on reforming payments and healthcare delivery. rice field. The omnibus report he needs in his package “really helps with more clarity,” LaRosa said.

In the 2021 reportthe Government Accountability Office has warned that using telemedicine could increase Medicare and Medicaid spending, and the Congressional Budget Office has historically said telemedicine has helped people access more healthcare. We have said that it will be easier and that spending could increase.

Proponents like Zebley counter that remote care isn’t necessarily expensive. “If the priority is to expand preventive care and access, then we need to take that into account when looking at costs,” said Zebley, noting that greater use of preventive care translates into higher spending. He said it could be reduced.

Siegel and his colleagues at Dartmouth College see remote care as a tool to help chronically ill patients receive continuous care and prevent costly emergencies. This “makes patients less sick,” he said. “It is important that this continues.”

Seigel’s work is partially funded by The Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also donates to her KHN.)

Over the past nine months, Dartmouth Health’s telemedicine visits have plateaued at over 500 per day. This represents his 10% to 15% of all outpatients, said Caitlin He Darling, director of operations for Dartmouth’s Virtual Care Center.

“Patients love it and want to keep doing it,” Darling said, adding that doctors, especially psychologists, also love telemedicine. If he decides not to continue funding, Darling fears patients will have to drive again for appointments that could have been handled remotely.

The leaders of Sanford Health, which serves the Upper Midwest, are plagued by the same concerns.

Brad Schipper, President of Virtual Care at Sanford, which has health policyholders, hospitals, clinics and other facilities in the Dakota, Iowa and Minnesota. In addition to the stipulation, Sanford is watching closely whether doctors continue to get paid for providing care across state lines.

During the pandemic, state licensing requirements are often relaxed to allow doctors to practice in other states, and many of these requirements are set to expire once the public health emergency ends. increase.

Licensing requirements aren’t addressed in the omnibus, and to ensure access to telemedicine, states must allow doctors to treat patients across state lines, said chief physician at Sanford Health. said Jeremy Cowells, Ph.D. This is especially important in providing mental health care, he said. Virtual visits now make up about 20% of Sanford’s schedule.

Sanford is based in Sioux Falls, South Dakota, and Cowells recalled one case where a patient was four hours away from the nearest childhood psychiatrist and was “on the other side of the border.” . Cauwels said the current license waiver has cut patient wait times from weeks to six, he said.

“We are able to go see the child without the mom taking time off to drive the car, without the six-week delay, and do virtually everything for the family. I made it.

Psychiatrist Dr. Sarah Gibson has used telemedicine for decades in rural Apache County, Arizona. “Some people just can’t get care without telemedicine,” she said. “It has to be added to the equation.”

Gibson, who is also medical director of the Little Colorado Center for Behavioral Health in Arizona, says one of the key questions for forward-looking policymakers isn’t whether telemedicine is better than face-to-face. . It’s “telemedicine vs. no care,” she said.

This story was produced by KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.

Sarah Jane Tribble: sjtribble@kff.org, @SJ Tribble