As Americans quarantined themselves during the COVID pandemic, telehealth has come into its own. The public health emergency caused Congress and Medicare to implement several waivers to the rigid rules that Medicare applies, resulting in an expansion from 13,000 telehealth visits per week for traditional Medicare beneficiaries prior to the pandemic, to 1.7 million per week in April 2020. Medicaid programs in 48 states and the District of Columbia issued guidance related to expanding telehealth coverage during the pandemic. Many private insurers also took action (voluntarily or not) to expand coverage of telehealth services. A report prepared for the National Association of Insurance Commissioners found that more than two-thirds of states took action to expand access to telehealth during the public health emergency, such as requiring coverage of telehealth; establishing temporary parity between payment for telehealth and in-person services; covering audio-only services in addition to audiovisual; and expanding eligible providers. Telehealth utilization rose from a negligible portion of total outpatient visits to approximately 12% in mid-2020.
Can we expect the telehealth expansion to remain, once COVID is finally in the rear-view mirror? While telehealth offers flexibility and convenience to health care consumers, there are several barriers to telehealth becoming a permanent part of the U.S. health care landscape. First, there is the digital divide: broadband access is limited for low-income Americans and some rural residents. Second, the effect of telehealth on overall quality of health care services is not well understood. Telehealth visits may be an inferior substitute for in-person care in many circumstances. On the other hand, greater use of telehealth may allow for more frequent monitoring for patients with chronic conditions, may increase access to specialty care for residents in rural areas and underserved communities, and may play a role in value-based care. Finally, there is the risk of overutilization, and out-and-out fraud. The Office of Inspector General of the Department of Health & Human Services uncovered approximately $4.5 billion in telehealth-related fraud in 2020.
Recent developments in the health insurance industry and in health information technology suggest that the industry is gearing up for telehealth to remain a feature in the health care landscape. In February, Cigna announced the acquisition of the telehealth platform MD, which it will integrate into its Evernorth subsidiary. The Digital Adoption Report published by Rock Health and the Stanford Center for Digital Health found that consumers who use telemedicine are highly satisfied with it, and that digital health trackers and wearables continue to gain in popularity. It would take Congressional action to continue the expanded Medicare coverage of telehealth that was allowed during the pandemic. Both the Senate and House of Representatives have held hearings on the topic, and several bills have been introduced on the topic.