| During the pandemic, Medicare has been paying for health care delivered virtually for a broader swath of patients. Many view that as a positive development for the future of health care in the United States — but the waivers for telehealth are headed for expiration at the end of the year. Yet there's a strong bipartisan push in Congress to make the shift toward telehealth permanent.Sen. Brian Schatz (D-Hawaii) is leading a bipartisan group of more than 50 senators that have introduced a bill to do just that. The Connect for Health Act would permanently remove geographic restrictions on telehealth, allow patients to do visits from their homes and grant the Health and Human Services secretary the permanent authority to waive telehealth restrictions. "We now face the expiration of these authorities and a scenario in which we could go back to the Stone Age in terms of reimbursement for telehealth," Schatz said. The bill is strongly bipartisan. Of the 57 co-sponsors on the bill, about half are Democrat and half are Republican. "Especially on health care, Democrats and Republicans have not seen eye-to-eye on anything at all for more than a decade. The single shining exception to that is telehealth," Schatz said.  Sen. Brian Schatz (D-Hawaii) has led the push for telehealth. (Al Drago/Pool via AP) | Rep. Mike Thompson (D-Calif) and other leaders in the House telehealth caucus are pushing for a similar legislation in the House. Other lawmakers want to take a more cautious approach. Rep. Lloyd Doggett (D-Tex.), chairman of the Ways and Means health subcommittee, has said that he intends to introduce legislation that would lift regulatory restrictions on telehealth, but only on a temporary basis. Doggett told The Health 202 that his bill to extend telehealth waivers through 2022 would give experts and regulators an opportunity to gather more data on telehealth and fashion a far-reaching proposal with more evidence. Doggett points out that the Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare issues, has recommended a limited extension. "[O]ur understanding of the impact of telehealth is largely limited to data and experience covering only a few months during a once-in-a-century pandemic," Doggett said. However it happens, telehealth could be here to stay.Americans have gotten used to talking to their doctors over phone or video chat over the past year. But Congress would need to act quickly to preserve the new normal. The regulatory changes that made expanded telehealth possible last only through the public health emergency. The Biden administration has said it anticipates the emergency will last through the end of 2021. Before the pandemic, Medicare generally only reimbursed telehealth visits for rural patients, who were required to go to a health-care setting to make the telehealth call. The pandemic changed all that. In an effort to support social distancing and keep people from making unnecessary trips to doctors' offices, the HHS secretary waived many of the restrictions on Medicare reimbursement for telehealth, making it possible for people in urban areas to use it and for patients to call from their homes.  (iStock) | The result: Americans got hooked on telehealth.Nearly two-thirds of Medicare beneficiaries reported last fall that their provider offers telehealth appointments, up from 18 percent before the pandemic, according to a Kaiser Family Foundation poll. The pandemic supercharged acceptance of telehealth among doctors and patients, according to Ateev Mehrotra, a hospital-medicine physician who researches telehealth at Harvard Medical School. "A change that would have occurred over a decade happened in the course of weeks, in terms of providers having these telemedicine visits and patients willing to do it," Mehrotra said. The devil is in the details.Lawmakers and regulators will need to determine what counts as a telehealth visit. Although Medicare has traditionally required video visits, during the pandemic, patients were allowed to connect over the phone. The decision of whether to allow phone calls as telehealth visits could have a major impact on access for those who have poor Internet connections. "Some beneficiaries are simply not going to be able to connect or participate in a telehealth service if they have to do it through a video-connected device," said Juliette Cubanski, deputy director for Medicare policy at the Kaiser Family Foundation. One thing that isn't in the leading bill proposals: Paying doctors the same for telemedicine visits as in-person visits.During the public health emergency, doctors have been able to bill the same amount for telehealth visits as they do for in-person visits. But many experts say that doesn't make sense long-term, given that providers can save on overhead when they use telehealth.  Former President Trump talks with a patient during a Veterans Affairs Department "telehealth" event in 2017. (AP Photo/Evan Vucci, File) | Even if telehealth services are billed at a lower rate, lawmakers are still concerned about costs.Supporters of telehealth laud its ability to reduce barriers to access, but fewer barriers to access can also mean that people use more health care, and that could come with increased costs. "The very strength of telemedicine is its ability to increase convenience and access to care, and it can also be viewed as its Achilles' heel. In some circumstances, it can be too easy to get care," Mehrotra said. "If you make things more convenient, people will use them more." The Congressional Budget Office hasn't scored the Connect for Health Act yet, but it has historically judged increased telehealth to spell higher costs. Yet Schatz, and other supporters, argue that high-cost estimates for telehealth are missing the savings that come from improving preventive care and shaving off overhead. "You're going to increase access, which means that theoretically you could increase the frequency with which people access care," said Schatz. "That strikes me as a good thing." | 
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