Elizabeth (Izzy) Montgomery, MPA
Telemedicine services grew rapidly over the past year and a half, facilitated by policy changes at both the federal and state levels in response to the public health emergency. A recent analysis by the Kaiser Family Foundation found that more than one in four Medicare beneficiaries had a telemedicine visit with a provider between the summer and fall of 2020. What role telemedicine should play in American health care beyond the pandemic is now an issue for policymakers to consider.
Prior to the COVID-19 public health emergency, traditional Medicare provided limited coverage for telemedicine services, requiring the patient to be in a remote or rural coverage area to be eligible to receive services. Medicare also only covered around 100 telemedicine services, including end-stage renal disease services, limited psychotherapy/mental health services, and subsequent hospital/nursing facility care services. During the pandemic, geographic restrictions on Medicare coverage for telemedicine services have been lifted and the list of telemedicine services covered by Medicare has been expanded ― but these changes are only in place for the duration of the public health emergency.
The expanded use of telemedicine during the pandemic has rallied advocates at the federal level, inspiring a push for permanent coverage by Medicare of enhanced telemedicine services temporarily authorized during the public health emergency. At the same time, there are growing concerns about the increased cost of expanded telemedicine services, the safety and efficacy of providing certain services through telemedicine, and the potential for fraud. Concerns about cost are supported by a recent Congressional Budget Office analysis of a bill that would remove geographic restrictions on Medicare coverage for mental health services provided through telemedicine, a change estimated to increase Medicare spending by $1.65 billion over the next decade.
During Arkansas’s recent legislative session, lawmakers passed several bills to extend coverage and reimbursement for telemedicine. The new laws, which are not limited to the duration of the pandemic, stemmed from temporary changes to existing laws through executive orders during the public health emergency. They include:
Telemedicine policy has developed more slowly in Arkansas than in other states, but the pandemic revealed opportunities to expand access to telemedicine services beyond the immediate crisis. As with any new opportunity, however, policymakers will need to watch for unscrupulous activities and unintended consequences, such as the potential impact of virtual-only providers on brick-and-mortar clinics in Arkansas. While telemedicine provides a much-needed option to deliver care to hard-to-reach populations, including residents in rural areas, it does not replace the need for in-person visits altogether. Striking a balance between healthcare services that can be provided on a virtual vs. in-person basis is unique to each patient’s circumstances.