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Letter to Congress on Post-COVID Telehealth Priorities
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Letter to Congress on Post-COVID Telehealth Priorities

July 26, 2021

The Honorable Charles Schumer
Majority Leader
United States Senate
Washington, DC 20510

The Honorable Nancy Pelosi
Speaker
United States House of Representatives Washington, DC 20515

The Honorable Mitch McConnell
Minority Leader
United States Senate
Washington, DC 20510

The Honorable Kevin McCarthy Minority Leader
United States House of Representatives Washington, DC 20515

RE: Priorities for Medicare Telehealth Reform

Dear Congressional Leaders:

Thank you for your leadership in expanding access to telehealth during the COVID-19 public health emergency
(PHE). Driven by swift action from Congress, the flexibilities enabled under the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act have allowed clinicians across the country to scale delivery and provide all Americans -- many for the first time -- access to high quality virtual care. In response, health care organizations across the nation have dramatically transformed and made significant investments in new technologies and care delivery models, not only to meet COVID driven patient demand, but to prepare for America’s future health care needs.

Unfortunately, this progress is in jeopardy. Many of the telehealth flexibilities are temporary and limited to the duration of the COVID-19 public health emergency. Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 PHE ends. This would have a chilling effect on access to care across the entire U.S. health care system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health.

Telehealth is not a COVID-19 novelty, and the regulatory flexibilities granted by Congress must not be viewed solely as pandemic response measures. Patient satisfaction surveys and claims data from CMS and private health plans tell a compelling story of the large-scale transformation of our nation’s health care system over the past year and, importantly, demonstrate strong patient interest and demand for telehealth access post-pandemic:

  • Telehealth is ubiquitous with more than 1 in 4 (15 million) of all Medicare beneficiaries accessing telehealth between the summer and fall of 2020.[1] Telehealth represented 0.22 percent of all medical claims for private health plans in December 2019, rising to 6.51 percent by December 2020.[2] In response, private payers are moving to expand telehealth post-pandemic[3] and meet new expectations from employers and plan members.[4]
  • Telehealth is popular with MedPAC noting that 91% of Medicare beneficiaries were satisfied with their telehealth video visits in its March 2021 report to Congress.[5] Patient satisfaction with telehealth across specialties and programs was high pre-pandemic[6] and has remained so during COVID-19.[7] 75 percent of Americans now report having a strong interest in using telehealth moving forward.[8] 
  • Telehealth is efficient with no-show rates for telehealth visits (7.5%) during the COVID-19 pandemic lower than both the no-show rates for in-office visits (36.1%) and a pre-pandemic in-office no-show rate (29.8%).[9] Providers and health systems continue to report on the significant and positive impact virtual care has had on operational efficiencies.[10]
  • Telehealth can help address existing health disparities and during the pandemic GAO found that the proportion of beneficiaries utilizing telehealth was relatively equal across racial and ethnic groups.[11] While investment is needed to address the digital divide – including broadband and funding for end user devices –researchers found significant value in leveraging telephone visits in extending access to underserved populations and enhancing FQHCs abilities to meet patient needs.[12] Before COVID-19, telehealth was seen as an important tool to deliver care to patients that had challenges with transportation, balancing responsibilities with hourly and seasonal jobs, accessing culturally sensitive providers, and – for the 46 million Americans in rural areas – traveling extreme distances to specialty and emergency care.[13]

With so many patients accessing care virtually, expectations for the future of our health care system have shifted significantly. Virtual care has provided unprecedented access for patients, but uncertainty as to the future of many telehealth policies will halt or reverse further adoption – to the detriment of both patients and providers. Congress not only has the opportunity to bring the U.S. health care system into the 21st century, but the responsibility to ensure that the billions in taxpayer funded COVID investments made during the pandemic are not simply wasted but used to accelerate the transformation of care delivery, ensuring access to high quality virtual care for all Americans.

Given the statutory restrictions in Section 1834(m) of the Social Security Act, Congress must act to ensure that the Secretary has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services. Secretary Becerra has recently asked for such authority,[14] and we urge bipartisan action toward this goal.

With these critical issues in mind, we ask that Congress advance permanent telehealth reform focused on the following priorities, at a minimum:

  1. Remove Obsolete Restrictions on the Location of the Patient and Provider. Congress must permanently remove the Section 1834(m) geographic and originating site restrictions to ensure that all patients can access care where they are. The response to COVID-19 has shown the importance of making telehealth services available in rural and urban areas alike. To bring clarity and provide certainty to patients and providers, we strongly urge Congress to address these restrictions in statute by striking the geographic limitation on originating sites and allow beneficiaries across the country to receive virtual care in their homes, or the location of their choosing, where clinically appropriate and with appropriate beneficiary protections and guardrails in place.
  2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and Modalities for Telehealth. Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, Congress should ensure that HHS and CMS maintain the authority to add or remove eligible telehealth services – as supported by data and demonstrated to be safe, effective, and clinically appropriate – through a predictable regulatory process that gives patients and providers transparency and clarity. Finally, Congress should give CMS the authority to reimburse for multiple telehealth modalities, including audio-only services, when clinically appropriate. 
  3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics Can Furnish Telehealth Services After the PHE. FQHCs, CAHs, and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act and through executive actions. Congress should ensure that FQHCs, CAHs, and RHCs can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers and better equip our health care system to address health disparities.
  4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services Offered Through Telehealth. Without Congressional action, a new requirement for an in-person visit prior to access to mental health services through telehealth will go into effect for most Medicare beneficiaries. We urge Congress to reject arbitrary restrictions that would require an in-person visit prior to a telehealth visit. Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities by restricting access for those individuals with barriers preventing them from traveling to in-person care.[15] Removing geographic and originating site restrictions only to replace them with in-person restrictions is short-sighted and will create additional barriers to care.

We look forward to working with you to build on the temporary telehealth expansion enacted in the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act to provide certainty to our nation’s health care providers and, more importantly, ensure Medicare beneficiaries can continue to access care when and where they need it. Congress must act before the PHE expires or providers and patients will lose access to high-quality virtual care.

Sincerely,

7wireVentures Academy of Nutrition and Dietetics Access Physicians
Activate Care AdvaMed Adventist Health
Adventist Health Policy Association agilon health Air MD physician Group
Air Visits Alameda Health System Allergy & Asthma Network
Alliance for Aging Research Alliance for Connected Care Alliance of Community Health Plans
Alliance of Health Care Sharing Ministries Allina Health Allscripts
Alpha Medical, Inc Amazon American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Neurology
American Academy of PAs American Academy of Sleep Medicine American Association for Respiratory Care
American Association of Colleges of Nursing American Association of Orthopaedic Surgeons American Board of Telehealth
American Cancer Society Cancer Action Network American College of Allergy, Asthma & Immunology American College of Obstetricians and Gynecologists
American College of Physicians American Diabetes Association American Foundation for Suicide Prevention
American Gastroenterological Association American Geriatrics Society American Health Care Association/National Center for Assisted Living
American Health Information Management Association American Heart Association American Lung Association
American Medical Association American Medical Group Association American Medical Rehabilitation Providers Association (AMRPA)
American Nurses Association American Occupational Therapy Association American Pharmacists Association
American Physical Therapy Association American Podiatric Medical Association American Psychiatric Association
American Psychoanalytic Association American Society for Gastrointestinal Endoscopy American Society of Nephrology
American Telemedicine Association American Urological Association Americans for Prosperity
America's Essential Hospitals America's Physician Groups Amwell
Me Therapy Array Behavioral Care Arthritis Northwest, PLLC
Ascellus Health Ascension Association for Behavioral Health and Wellness
Association of American Cancer Institutes Association of American Medical Colleges Association of Asian Pacific Community Health Organizations (AAPCHO)
Association of Black Cardiologists Association of Community Cancer Centers (ACCC) Association of Departments of Family Medicine
Association of Diabetes Care & Education Specialists Association of Family Medicine Residency Directors Association of Oncology Social Work
Athenahealth Avel eCARE Aventyn, Inc.
Avera Health Babylon BAKERS Counseling Services LLC
Banner|Aetna Barstow Community Hospital Bay Rivers Telehealth Alliance
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Catholic Health Association of the United States Center for Dignity in Healthcare for People with Disabilities Center for Freedom and Prosperity
Center for Rural Health Innovation Center for Telehealth, University of Mississippi Medical Center Center to Advance Palliative Care (CAPC)
Centerstone Centura Health CEO Action for Racial Equity
Challenge Behavioral Healthcare Change Healthcare Cheyenne Regional Medical Center
Children’s Health Fund Children’s National Hospital ChristianaCare
CirrusMD Inc. CityLife Health, LLC Cleveland Clinic Florida and CompreCare Affiliate
Clinical Social Work Association CMG/Carealytics Coalition for Compassionate Care of California
Coalition for Headache and Migraine Patients Colorado Community Health Network Columbia University Irving Medical Center
CommonSpirit Health Commonwealth Clinical Group, Inc. CommonWell Health Alliance
CommonWell Health Alliance Compassion & Choices Compodium, Inc
Comprehensive Psychiatry Group, Inc Conemaugh Meyersdale Medical Center Connected Health Initiative
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Consumer Technology Association Convenient Care Association Cromford Health
Curve Health Dartmouth-Hitchcock Health DayaMed
Diabetes & Endocrinology Consultants of PA, LLC Digital Medicine Society (DiMe) Digital Therapeutics Alliance
DigitalOptometrics LLC Dignio LLc / AS Doc Leon Travel & Concierge Medicine
Doctor On Demand DoseCue, LLC Duke Health
Eating Disorders Coalition for Research, Policy & Action eHealth Initiative Eleanor Health
Electronic Health Record Association Electronic Healthcare Network Accreditation Commission (EHNAC) Ellis County Coalition for Health Options DBA Hope Clinic
Emory University Encounter Telehealth Endocrine Society
Envision Healthcare Epic Systems Corporation Epilepsy Foundation
eVisit, Inc. ExamMed Family & Children's Counseling Services
Family & Children's Service of Ithaca Federation of American Hospitals Fight Colorectal Cancer
Firstvitals Health and Wellness Foothold Technology Forefront Telecare, Inc.
Fresenius Medical Care North America Galileo Analytics Global Liver Institute
GlobalMedia Group, LLC DBA GlobalMed(R) GlyCare GO2 Foundation for Lung Cancer
Go2Care Google Grapevine Health
Greenway Health Gundersen Health System Hawai'i Parkinson Association
Hazel Health Hazlewood Medical LLC HCA Healthcare
HCU Network America HD Reach Health Business Consult
Health Care Transformation Task Force Health Choice Arizona Health Innovation Alliance
Health Tech Strategies, Inc Healthcare Leadership Council HEALTHePRACTICES
Healthwise, Incorporated HealthyWomen Heart Failure Society of America
Henry Ford Health System Heritage Provider Network Hicuity Health, Inc.
Hillrom Hims & Hers HIMSS
HIMSS Central & North Florida Chapter HIMSS Greater Illinois Chapter HIMSS Iowa Chapter
HIMSS KY Bluegrass HIMSS Minnesota Chapter HIMSS National Capital Area
HIMSS NYS Chapter HIMSS South Carolina Chapter HIMSS Southern California Chapter
HiTalk HMRCOUNSELING and Behavioral services Hospice and Palliative Nurses Association
HSA Coalition ICmed, LLC IHE USA
Indiana Oncology Society Indiana University Health Indo Us Organization for Rare Diseases
Infectious Diseases Society of America Ingham Community Health Centers innovaTel Telepsychiatry
Institute of Respiratory Disease and Sleep Medicine International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis) International OCD Foundation
Iowa Oncology Society Iron Bow Technologies IT Consulting Group LLC
IthacaMed Jeeva Informatics Solutions LLC Johns Hopkins Medicine
Joyages JR & Associates Kaiser Permanente
Kentucky Counseling Center, LLC Kohnlinq, Inc. Leadership OD
Legal Action Center Less Government Lewy Body Dementia Association
LifePoint Health LifeWIRE Corp LiV-Connected
LT Telehealth/LocumTenens.com Lupus and Allied Diseases Association, Inc. Mardac Consulting
Marshfield Clinic Health System Mass General Brigham Massachusetts Health Data Consortium
Mayo Clinic MDH Consulting International Medical Group Management Association
Medical Image Perception Society Medocity, Inc. MedStar Health
MedWand Solutions Inc. Memorial Sloan Kettering Mend VIP, Inc.
Mental Health America Michigan Health & Hospital Association Michigan Health Information Network
Midwest Health Connection Miles for Migraine Millennium Physician Group
Missouri Oncology Society Moffitt Cancer Center Monebo Technologies, Inc. Montana State Oncology Society Monument Inc
Moonshot Health Consulting Mosaica Partners Motivo
MPAC Healthcare Multiple Sclerosis Center of Atlanta NACBHDD and NARMH
National Association for Healthcare Quality National Association for the Support of Long Term Care (NASL) National Association of Community Health Centers
National Association of Pediatric Nurse Practitioners National Association of Rural Health Clinics National Association of Social Workers
National Athletic Trainers' Association National Brain Tumor Society National Coalition for Hospice and Palliative Care
National Council for Mental Wellbeing National Council of State Boards of Nursing National Health Care for the Homeless Council
National League for Nursing National Mental Health LLC National Multiple Sclerosis Society
National Nurse-Led Care Consortium National Organization for Rare Disorders National Patient Advocate Foundation
National Psoriasis Foundation NeuroPath Nebraska Medicine New Jersey Association of Mental Health and Addiction Agencies, Inc. Nemours Children's Health New Mexico Society of Clinical Oncology
NextGate NextGen Healthcare Nicklaus Children's Health System
North American Primary Care Research Group Northwell Health OCHIN
Oncology Nursing Society Onduo LLC One Medical
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Partnership to Advance Virtual Care PAs in Virtual Medicine and Telemedicine (PAVMT) PCHAlliance
Peaceful Roots Counseling LLC Physician Assistants in Hospice and Palliative Medicine Population Health Alliance
Premier Preventive Cardiovascular Nurses Association Primary Care Collaborative
Primary Care Development Corporation Prism Health North Texas ProMedica
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QuartetHealth Qure4u, Inc Real Time Touch
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SCL Health Scripps Health SENTARA Healthcare
Setauket Primary Medical Care Seven Valleys Health Coalition SHIELDS for Families, Inc.
Skypiatrist Psychiatry PLLC Small Business & Entrepreneurship Council SOC Telemed
Society for Participatory Medicine Society of General Internal Medicine Society of Hospital Medicine
Society of Teachers of Family Medicine South Central Human Relations Center, Inc. Speck
Spina Bifida Association St. Mary's Medical Center, a member of Mountain Health Network Stanford Children’s Health
Stanford Health Care Steuben County Public Health Strategic Health Information Exchange Collaborative (SHIEC)
Strategic Integration Solutions, Ltd. Summit Healthcare Association Summit Healthcare Regional Medical Center
Synecor, LLC TapestryHealth Teladoc Health
Telehealth Alliance of Oregon Telekids Therapy TeleMed2U
Telemedicols LLC TeleMedik Texas e-Health Alliance
The Arizona Clinical Oncology Society The Center for Discovery The Center for Youth & Family Solutions
The Children's Home of Wyoming Conferenc The College of Healthcare Information Management Executives (CHIME) The ERISA Industry Committee
The Headache and Migraine Policy Forum The Jewish Federations of North America The Joint Commission
The Michael J. Fox Foundation for Parkinson's Research The University of Texas at Austin, UT Health Austin Third Eye Health, Inc.
Tir Health Advisors LLC Tompkins Community Action, Inc. Tourette Association of America
Travere Therapeutics Trinity Health TW Ponessa & Associates Counseling Services, Inc.
U.S. Pain Foundation UBHS INC UCHealth
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University of New Mexico College of Nursing University of Pittsburgh Medical Center (UPMC) University of Wisconsin Hospitals and Clinics
Upward Health URAC UVA Health
Velatura HIE Corporation Velatura Services VIKRITI Management Consulting
Virginia Association of Hematologist & Oncologist Virginia Pediatric Group Vital Voice and Speech LLC
ViTel Net VoCare, Inc. Volunteers of America of North Louisiana
Vynca, Inc. WhiplashMD, LLC Wisconsin Association of Hematology & Oncology
Wyoming State Oncology Society X4 Health XEN Partners
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