Telehealth will disappear in three weeks without congressional action

Telehealth will end on December 31 unless Congress takes urgent action to pass the Telehealth Modernization Act of 2024.

Before COVID, Medicare provided limited coverage for telehealth and limited it primarily to patients in rural areas. They had to go to a local hospital or clinic to contact a specialist until early 2020. At the beginning of the COVID-19 pandemic Medicare significantly expanded coverage to admit patients anywhere, so that they have access to specialist care from home. The expanded services also include physical and occupational therapy, emergency department visits and telehealth care. This expansion caused concern Medicare’s 64 million enrollees and expanded pre-existing access for 76 million low-income Americans on Medicaid.

It’s not just patients on Medicare/Medicaid who should be concerned if this bill isn’t renewed. Private insurers often follow Medicare’s lead regarding the services they will cover.

Congress.gov summarizes H.R. 7623 Telehealth Modernization Act of 2024 as follows: “This bill changes the requirements regarding coverage of telehealth services under Medicare.

Specifically, the bill permanently expands certain flexibilities initially allowed during the public health emergency related to COVID-19. The bill, among other things, allows (1) rural health clinics and federally qualified health centers to serve as a remote location (i.e., the location of the health care provider); (2) a beneficiary’s home that serves as the originating location (i.e., the beneficiary’s location) for all services (rather than just certain services); and (3) all types of practitioners to provide telehealth services as determined by the Centers for Medicare & Medicaid Services.”

Why is telehealth important?

The ability to access medical care remotely has been a huge boon for many, especially in rural areas and for people with disabilities.

Jessica Offir, PhD, is a disability health advocate and social psychologist for whom telemedicine is a priority. She noted that a stumbling block to the law’s extension is that “insurance companies have not wanted to pay the same amounts as for personal care, but providers have pushed for it.” She added: “Trump also wants to reduce Medicare and Medicaid payouts, and this is one way to make that happen, as telehealth has vastly increased access to health care for the elderly and disabled. If you take away access, payments decrease. The only entities that benefit from this are insurers.”

My own family is a staunch supporter of access to telemedicine. We live in western Maryland, a three-hour drive from the University Hospitals in Washington/Baltimore. Since I can’t drive that far, I’m increasingly relying on remote services, especially for specialties that are poorly represented in our city. If telemedicine services are discontinued, I will no longer have access to some of the specialties I need. Someone brings me twice a year for personal examinations. These feel increasingly dangerous to my health for two reasons: one is the worsening traffic and freight on the highway. The other is that my family still recognizes that the COVID-19 pandemic has not terminated, our providers have not. They have stopped masking and even turned off HEPA filters in exam rooms and waiting rooms, leaving them deserted and useless. I take an Aranet CO2 monitor with me everywhere and try to educate people. On a recent visit, the CO2 level went from 600 ppm when I entered the exam room, to 1704 ppm before I left! That’s a level that can make you drowsy and impair your judgment. I explained to the doctor that each breath was 3.4% re-breathed air from someone else The study of SN Rudnick and Don Miltonpopularized by David Elfstrom‘s reference table. That got his attention and recognition of his potential risk for a Covid or other respiratory infection.

My experience is not unique. A recent article found that more than 17 percent of older Medicare beneficiaries report the same difficulty traveling to the doctor’s office. That year, people over 65 had an average of about 17 contact days for outpatient care. That increased to 30 contact days per year for the 14 percent of patients with ten or more chronic diseases – a significant time and energy burden.

Another one study of cancer patients found (73.8%) rated their first telemedicine visit as good or better than an in-person visit, and 4606 (18.9%) rated it as superior. Another striking example is those who received care through telecare with peer assistance were almost seven times more likely to be treated for hepatitis C and four times more likely to achieve viral clearance after six months.

One bit of good news is that the U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) announced on November 15 that they will expand telemedicine flexibility until 2025. This is an important victory for access to medication in end-of-life care. More than 40,000 comments were submitted to the DEA.

Paying for telehealth is now a major issue, although there is bipartisan support for the bill. A Republican House staffer explained that “Medicare beneficiaries are on a cliff and will lose teleservices after December 31, 2024.” Congress is negotiating how long a new extension could look like and where the funding will come from, but the two sides have not yet reached an agreement.

There have been higher costs per person with more telecare is used. On the other hand, telemedicine can improve patient compliance with medications and reduce expensive emergency room visits.

You can argue about the relative costs, but the bottom line is that there are people behind these figures: largely disabled, elderly and rural residents. There are some concerns about ensuring the quality of care, but these appear to be minor.

The Action network encourages people to write to their representatives in Congress urging them to pass this Telehealth Modernization Act before the end of the year. It’s the only chance to save it. With the news of planned cuts in government spending, there is no time to lose.

As Offir reminds us, “Again, the people who will be most harmed are the vulnerable populations who can least afford it.”

You can contact your Chamber representatives here, and senators here.

Note: I have reached out to the offices of several of the bill’s co-sponsors to ask what obstacles remain with no response, except from the office of one Republican in the House of Representatives.