“Providers and patients like telehealth, so let’s do our best not to mess this up.”
Washington, D.C. (March 3, 2021) – U.S. Rep. Markwayne Mullin (R-OK), perhaps, understands better than anyone in Congress the positive impact last year’s expansion of telehealth services can have on a family.
“Sorry, I’m a little later to the discussion, I was just on the phone with my son’s neurologist,” he explained to those taking part in a House hearing entitled “The Future of Telehealth: how Covid-19 is changing the delivery of virtual care.”
According to Mullin, his teenage son suffered a traumatic brain injury in March 2020 in an accident while playing with his brothers. The representative credits the lifting of interstate regulations on telehealth, which were changed in response to the pandemic, as one reason his son is receiving the best care available.
“We meet with his doctors via telehealth,” said Mullin. “UCLA has taken on his case. A specialist in Beverly Hills is overseeing it. We also work with another specialist in Illinois, and all while we are living in rural Oklahoma. Telehealth has opened up an opportunity to all of us to have access to the specialists we or our families need no matter where we live.”
While the lawmaker calls the pandemic “horrific” he acknowledges the silver lining—that there have been advancements in the use of telehealth. But, despite moving quickly, he adds that Congress “wasn’t quite ready.”
“We didn’t yet know how to reimburse doctors for it, regulate it, and handle the technology,” he told
Addressing those types of questions is why the House Subcommittee on Health, which is part of the Committee on Energy and Commerce, held a hearing Wednesday. It featured expert testimony from leaders with the American Medical Association, Harvard Medical School, and the Medicare Rights Center, among others.
They focused on the opportunities, challenges, and dangers to expanding telehealth in a post-pandemic world. You can find a full wrap-up of their testimonials here.
U.S. Rep. Anna Eshoo (D-CA) led the hearing—calling telehealth a “bipartisan issue that lawmakers should make easier for all patients to access and use.” Lawmakers from both sides of the aisle took part in the hearing, asking the panel of experts questions that range from payment to privacy. Below are examples of just some of those exchanges (please note: some quotes are paraphrased):
Q – Rep. Eshoo: Have any of you examined the Connect Bill?
A – Dr. Jack Resneck, Board of Trustees, American Medical Association (AMA): We’ve been supportive and appreciative of the lifting of regulations, but we prefer the Telehealth Modernization Act. We like adding permanent repeal of rural exclusions rather than doing ongoing waivers which is the approach of CMS (Centers for Medicare & Medicaid Services).
Q – Rep. Eshoo: Will telehealth increase utilization and, in turn, increase cost?
A – Dr. Megan Mahoney, Chief of Staff, Stanford Health Care: We have to ask, “what does it mean when we use the word ‘utilization?’” What takes the physician’s time?
A – Dr. Ateev Mehrotra, an Associate Professor of Health Care Policy at Harvard Medical School: It’s hard to use the data from the pandemic to answer that. Look at a period prior to the pandemic but we don’t have that much research on the topic. We really need more data.
Q-Rep. Brett Guthrie (R-KY): What do we know about the vulnerabilities of telehealth or what’s appropriate for different clinical needs?
A-Elizabeth Mitchell, President and CEO, Purchaser Business Group on Health: There’s little right now that’s written about telehealth as an alternative to in-person care. I think research is needed on clinical effectiveness. We need to measure the service and see what happens when it’s integrated.
A-Frederic Riccardi, President, Medicare Rights Center: Having access to the technology is difficult for some. Waivers have helped with use of technologies, but we also need make sure HIPPA is implemented to protect patient information
Q- Rep. Frank Pallone (D-NJ): What about the payment system? Medicare’s fee-for-service system could add to the issue of cost.
A- Dr. Mehrotra: Telehealth does increase utilization and that can increase cost.
A-Mitchell: We should move away from fee for service and, instead, thoughtfully increase the use of telehealth [where and how it makes the most sense for doctors and patients.]
Q-Rep. Kathy Castor (D-Fl): I’ve heard that’s telehealth is an important connection during an enormous disconnection during the pandemic, and CMS added a number of telehealth services that are now covered. What’s still needed? What should we look at next?
A-Riccardi: There are many who still need to have access to broadband or the technology to use telehealth. We must ensure everyone has access to this
A-Dr. Mahoney: We need to look at where we should prioritize the data. We really to need to complete peer research to explain quality and cost between in-person and virtual care. We also need to make sure patients have access to internet and a computer and place a priority on digital literacy and look at t how impacts the health outcomes.
Q-Rep. Michael Burgess* (R-TX): There are going to be significant differences based on practice type and I hope we recognize that as we discuss telehealth usage. Have you been looking at that?
A-Dr. Resneck: We (the AMA) have a pretty large understanding about what works with specialty care among doctors. We just do not want to see the issue put into statute because it really does evolve over time.
* Rep. Burgess also is a physician
Q-Rep. Peter Welch (D-VT): Unless we address the cost of healthcare, we’re going to lose access to healthcare. Ms. Mitchell, how can we lower cost if we have fee for services—more services you provide the more money you make?
A-Mitchell: Affordability is a crisis. It’s a drag on employers who are providing it for their employee. Just adding another service to the fee for service system is not optimal. Instead, we should work at expanded access to primary care physicians because this ultimately reduces visits to the emergency room. There are many ways we can be intentional and smart about integrating it.
A-Rep. Morgan Griffith (R-VA): I oversee a poor area of the mountains and telehealth is helping them get care, but I’m also worried about our people getting broadband because it’s too expensive. What’s your opinion on audio only versus video patient interactions? When is it appropriate for audio only?
A-Dr. Resneck: It’s technically not our first choice but it can be a lifeline for rural or low-income areas. I’m surprised how many of my patients don’t have broadband even in urban areas. Who among us today has not have a team meeting go awry? Yet, we still have entire native American reservations with no broadband access. We have black and brown communities that have particularly less broadband access.
Q-Rep. Griffith: There are so many pockets with no broadband. Do you believe providers should receive a lower for audio only?
A-Dr. Resneck: I don’t. The audio is just another method of delivering care. It’s not the care itself. The doctor is still putting in that time and using staff.
Q-Rep. Raul Ruiz* (D-CA): I believe that home and community-based healthcare is the future. It’s already there organically. It’s leading to lower costs, better health outcomes, and patients and providers are happier. How do we make better use of the community health worker? I don’t want to leave behind the same communities are being left behind.
A-Dr. Mahoney: Telehealth can help patients who have been historically underserved by tapping into the resources and other caregivers in the community. But we must help some overcome digital literacy while also using culturally sensitive language. I’ve seen as a frontline provider that those barriers can be overcome.
Q-Rep. Ruiz: How do we increase accessibility for all especially for those who can’t “go”? Such as seniors who can’t drive, the farmers who can’t afford to take off for hours, for the single mom who can’t see a doctor? How can telehealth also help expand the use of home health care?
A-Dr. Mahoney: I firmly believe telehealth can extend access to all kinds of care—from pharmacists to physical therapists and more. We can also focus telehealth resources in ways that can help reduce the cost of care.
* Rep. Ruiz also is a physician
Q-Rep. Larry Bucshon* (R-IN): Providers and patients like telehealth so let’s do our best not to mess this up. It’s too bad that it took a pandemic to finally get us to recognize that we needed to make advancements in telehealth. As a physician, I believe doctors should be reimbursed appropriately based on the standard of care. What are your thoughts on this?
A-Dr. Resneck: I do agree. Telehealth is a mode of delivering service not the service itself. The cost should be based on time. Telemedicine is hard to do and a lot of work but paying equitably makes a lot of sense.
Q-Rep. Buschon: How should we address the liability issue? The idea that something is misdiagnosed, doctors are held liable. But what if a patient’s camera or connection isn’t strong and we couldn’t see something?
A-Dr. Resneck: Those our serious questions. Liability reform is on a lot of doctor’s minds. We can’t be held accountable for what we weren’t shown or can’t see but we hold physicians to an ethical standard in care. So, if you see that you need to see it in person, that you’re not getting what you need to make a proper diagnosis, then that needs to be indicated. That same standard of care is necessary. The standard of care should be the same
* Rep. Bucshon is also a physician
Q-Rep. Debbie Dingell (D-MI): This is such an important and very timely hearing. Telemedicine is here to stay but we need to thoughtfully explore reforms and really build what works and come together in a bipartisan way. How do you think we can do that?
A-Riccardi: We can draw on previous experiences with fraud, waste, or abuse. We need to consider the privacy concerns that many older adults have, and as we consider how to protect our seniors we don’ t want to arbitrarily impose challenges on older patients. So, we also need to be investing in the infrastructure of the tech that’s needed (broadband and related technologies) and while supporting the community-based organizations for seniors that can help them combat and understand scams.
Despite some of the challenges and the questions that remain, the use of telehealth is not likely to go back to pre-pandemic levels. A fact that Rep. Mullin says has impacted his life—and can have long-term impact the health care system in America.
“At first, I didn’t know if I ‘d like it but as I started to work through it, I became the doctor’s assistant which really helped because I am the caregiver for my son,” he said. “I understand now how to help him and am part of his team.
“Dr. Resneck – do you think that we need to coordinate telehealth and have a national approach? Perhaps elevate it to HHS (the Department of Health and Human Services)?”
“Our observation is that CMS has been incredibly responsive in making changes,” said Dr. Resneck. “But this is an important issue and we do need to continue to have a national strategy.”
To watch the hearing in its entirety, head to this link.
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