US Congress faces pressure to maintain telehealth after COVID-19

The coronavirus pandemic has forced healthcare systems around the world to make greater use of telehealth services during lockdown, and lawmakers in the US want to see if those changes could be permanent.

Representative Robin Kelly (Democrat – Illinois) tabled a bill in the House on at the beginning of the month that would ask the Department of Health and Human Services (DHHS) to study the effects of changes to telehealth caused by COVID-19 on the federal Medicare and Medicaid programmes.

The schemes provide healthcare cover to the over-65s and those on low-income, respectively, and Rep Kelly and the co-signatories of bill HR 7078 want the DHHS to provide data on the types of telehealth and their costs during the outbreak, as well as uptake.

They also want to gauge whether greater use of telehealth has increased the risk of fraud and other illicit activities like ransomware attacks or cybersecurity breaches, and what has been done by the federal government to mitigate those risks.

The bill asks for an interim report from the DHHS within a year of the emergency ending, and a final version by the end of 2024, and also asks for funding to be made available for states to carry out their own assessments.

There are other state- and federal-level initiatives underway to try to make the changes enforced by the coronavirus pandemic a permanent feature of the US healthcare landscape.

Last month, for example, a group of more than 30 members of Congress wrote a letter to House Speaker Nancy Pelosi and her counterpart in the Senate, Mitch McConnell, to ask that emergency approval of behavioural telehealth services be extended for a transition period after the crisis ends.

These services are “proving to be an extremely successful approach in ensuring that patients are receiving mental health and addiction care during this trying and unprecedented time,” said the letter.

In particular, reimbursement of audio telephone consultations has been a lifeline for people living in rural communities and those without video-enabled telecoms devices, it added.

The signatories want Congress to maintain these provisions “for a reasonable transition period following the COVID-19 emergency period to collect appropriate data to provide an adequate amount of time to determine which of those flexibilities should be continued permanently.”

The moves come against a backdrop of resistance among some in Congress, who argue that there isn’t enough data to support the expansion of technology in healthcare delivery.

Rep Kelly told Politico that her bill aims to change that by gathering “as much information and really study the issue quickly before…regulations run out.”

Commenting on the increasing pressure on Congress to make these changes permanent, Lux Research analyst Danielle Bradnan said that legislators are concerned about broadband internet access, payer reimbursement, and licensure barriers – as currently, medical licenses are only valid for specific states.

The telehealth sector “should pay close attention to how these concerns are addressed because policy changes may mean greater opportunities for clients that can provide thoughtful connectivity support, as well as more opportunities to provide telehealth tools (including remote monitoring devices) to a wider and more homogeneous array of healthcare providers.”

She adds: “With legislative support, clients should expect the telehealth landscape to grow rapidly, as many telehealth companies have been ready for years and need to develop a strategy now in order to be competitive."