OIG urges telehealth policy shift from pandemic to long-term

Based on its telehealth services review, OIG urged federal authorities to adopt pandemic expansions into permanent telehealth policy.

By admin

Sep 13, 2022, 10:51 AM

Telehealth policy flexibilities dramatically improved access to remote services for Medicare beneficiaries during the first year of the COVID-19 pandemic, particularly for medically underserved populations, according to a report from the Department of Health and Human Services Office of Inspector General (OIG).

In a companion analysis released earlier this year, OIG found that about 40 percent of Medicare beneficiaries used telehealth services between March 1, 2020, and February 28, 2021. In total, beneficiaries used nearly 90 times more telehealth services in the pandemic’s first year than they did in the prior year, when the Centers for Medicare and Medicaid Services (CMS) restricted telehealth mainly to medical facilities located in rural areas.

OIG highlighted that beneficiaries in urban areas were more likely (45 percent of beneficiaries) than those in rural areas (33 percent) to use telehealth during the study period. Overall, beneficiaries across urban and rural areas almost always used telehealth from home or other non-healthcare settings.

Further, beneficiaries dually eligible for Medicare and Medicaid were more likely to than others to use telehealth services. OIG noted that dually eligible beneficiaries (enrolled due to age, disability or low income) outpaced Medicare-only beneficiaries in telehealth use “regardless of race and ethnicity, and whether they lived in rural or urban areas.”

Additionally, CMS allowed expanded of use of audio-only telehealth services during the pandemic, in contrast to previously instituted audio-video requirements with few exceptions. An estimated 19 percent of all Medicare beneficiaries used audio-only services during the first year of the pandemic, and the vast majority did not connect via combined audio/video services, suggesting an audio-only preference (especially among those age 75 and older) or barriers to using audio-video telehealth.

Telehealth policy next steps

As part of the government’s omnibus spending package signed into law in March, Congress extended telehealth flexibilities for 151 days following a declared end to the COVID-19 public health emergency. In July, the U.S. House of Representatives passed the Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040), which would put in place telehealth waivers through the end of 2024. H.R. 4040 awaits action in the Senate, where the bill has been referred to the Finance Committee.

In the interim, OIG’s report recommended that CMS take “appropriate steps to enable a successful transition from pandemic-related flexibilities to long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary’s home.”

OIG added that CMS should temporarily extend the use of audio-only telehealth services and then evaluate the impact of those services on beneficiary access, equity, cost, quality of care, and program integrity. OIG said CMS should use that analysis—along with feedback from other stakeholders—to determine whether to permanently expand the use of audio-only services and if any limitations should be established. For instance, CMS could allow audio-only telehealth services strictly for providers with whom the beneficiary has an established relationship or when the beneficiary has periodic in-person visits with the provider.

Also, OIG noted that CMS currently requires providers to use a modifier when billing for audio-only services for treatment of mental health conditions. OIG advised CMS should require providers to use the modifier to identify all telehealth services provided on an audio-only basis in preparation for more permanent action.

Finally, OIG emphasized that dually eligible, Hispanic, younger and female beneficiaries were more likely to use telehealth during the pandemic’s first year, revealing that telehealth’s expansion particularly helped those groups. Accordingly, CMS could leverage permanently expanded telehealth provisions to help close gaps in care access among medically underserved populations.

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare, technology and sports.