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Congress lines up to support permanent changes to telehealth rules


Also in Washington, physicians and MedPAC back site-neutral payment for in-person care.

people digital health: © Gstudio - stock.adobe.com

© Gstudio - stock.adobe.com

Telehealth changes that helped physicians and patients during the COVID-19 pandemic could become permanent under a new bill pending in Congress.

Meanwhile, another leading physician group is supporting site-neutral payment for medical services. The two issues have sparked renewed discussion this month due to proposals by federal policy makers.

CONNECT in Congress

A bipartisan group of 60 senators have reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023.

U.S. Sen. Brian Schatz, D-Hawaii, said the legislation is becoming urgent because telehealth provisions allowed during the pandemic were continued through 2024, but they will expire.

“While telehealth use has skyrocketed these last few years, our laws have not kept up. Telehealth is helping people in every part of the country get the care they need, and it’s here to stay,” Schatz said in his announcement of the legislation. “Our comprehensive bill makes it easier for more people to see their doctors no matter where they live.”

Pre-pandemic help

Much of the CONNECT Act predates the pandemic – it was first introduced in 2016 and some of its rules have been implemented, according to the senators. For example, physicians have greater ability to used telehealth for mental health services, stroke care, and home dialysis.

Still needed are allowances such as removing geographic restrictions on telehealth services and expanding originating sites to include homes. Health centers, rural health clinics, and other eligible health care professionals also could provide telehealth.

The bill would require more study of how telehealth is used, how it affects quality of care, and how to improve it.

“Telehealth is a revolutionary development in health care delivery. The Internet put communications and commerce in the palm of our hand, and it is now doing the same for health care,” cosponsor Sen. Roger Wicker, R-Mississippi, said in a statement. “After years of dedicated efforts, I am pleased to see the growing support for making flexibility in telehealth delivery permanent. The CONNECT for Health Act will move us toward Medicare beneficiaries receiving the healthcare they deserve.”

A number of physician and other health care groups are supporting the CONNECT Act.

Conflicting views on telehealth

The bill was announced the same day as the 2023 report to Congress of the Medicare Payment Advisory Commission (MedPAC). It did not make a formal recommendation about Medicare’s future handling of telehealth services, but did repeat its March 2021 argument that the U.S. Centers for Medicare & Medicaid Services should resume paying lower rates for telehealth services “as soon as practicable after the PHE,” the COVID-19 public health emergency that ended May 11.

That is the wrong approach, according to the American College of Physicians (ACP), which shared a response with Medical Economics. Its members are “very concerned” about potential reductions in payments for telehealth services.

“Over the COVID-19 public health emergency, we saw a large uptick in the number of services provided by telehealth,” the ACP statement said. “Expanding the role of telehealth as a method of health care delivery has the potential to enhance patient-physician collaboration, improve health outcomes, increase access to care, as well as access to members of a patient’s health care team, and reduce medical costs. Reducing reimbursement for these services will diminish the potential of this important means of health care delivery.”

Site-neutral payment

As for in-person health, ACP supported MedPAC’s recommendation to Congress for site-neutral payments for physicians, instead of payment tiers based on the location of health services.

“There is no justification for patients and the Medicare program paying more for a visit when the service is provided in an office owned by a hospital than for the same type of visit in an independent physician practice,” the ACP statement said. “Adding fees to services based merely on who owns the facility where the service is performed in no way reflects the value of services provided.”

The issue has become divisive within health care. Patients have complained publicly about higher costs to them due to service prices based on location. Hospitals counter that greater reimbursement helps them cover costs that physicians’ offices don’t have. The American Hospital Association has argued site-neutral payment would hurt rural hospitals, making an average negative operating margin even worse.

ACP and the American Academy of Family Physicians both are part of the Alliance for Site Neutral Payment Reform, a coalition of “patient advocates, providers, payers, and employers who support payment parity” regardless of location.

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