Nearly two hours into a Capitol Hill hearing focused on rural health, Rep. Brad Wenstrup emphatically told the committee\u2019s five witnesses: \u201cHang with us.\u201d<\/p>\n

Federal lawmakers face a year-end deadline to solidify or scuttle an array of covid-era payment changes for telehealth services that include allowing people to stay in their homes to see a doctor or therapist.<\/p>\n

During the hearing<\/a> in early March, Wenstrup and other House members offered personal anecdotes on how telehealth, home visits, and remote monitoring helped their patients, relatives, and constituents. Wenstrup, a Republican from Ohio who is also a podiatric surgeon and a retired Army reservist, told the audience: \u201cPatients are less anxious and heal better when they can be at home.\u201d<\/p>\n

Most of the proposals focus on how Medicare covers telehealth services. But the rules affect patients on all types of insurance plans because typically private insurers and some government programs follow Medicare\u2019s example. Without congressional action, virtual health care services like audio-only calls or meeting online with specialty doctors \u2014 such as an occupational therapist \u2014 could end. The bills would also continue to allow rural health clinics and other health centers to offer telehealth services while waiving a requirement for in-person mental health visits.<\/p>\n

Telehealth use ballooned in the early months of the covid-19 pandemic and grew into a household term. The practice has become a popular issue for lawmakers on both sides of the aisle.<\/p>\n

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In one U.S. Census Bureau survey<\/a> conducted from April 2021 to August 2022, Medicare and Medicaid enrollees reported using telehealth visits the most \u2014 26.8% and 28.3%, respectively. The survey of nearly 1.2 million adults also found that Black patients and those earning less than $25,000 reported high rates of telehealth use. Notably, people of color were more likely to use audio-only visits.<\/p>\n
Ensuring access to telehealth services \u201cis the best public policy,\u201d said Debbie Curtis, a vice president of McDermott+Consulting, a Washington, D.C.-based health care lobbying firm. \u201cIt\u2019s the best business outcome. It\u2019s the best patient care outcome.\u201d<\/p>\n
But it\u2019s a presidential election year and Congress is a \u201cdeadline-driven organization,\u201d Curtis said. She expects that Congress will be \u201ckicking the can\u201d past the November election.<\/p>\n
Kyle Zebley, senior vice president of public policy at the American Telemedicine Association who also lobbies on Capitol Hill, said Congress \u201cmight well be in that lame-duck period.\u201d \u201cThis is no way to run a health care system on a popular bipartisan issue,\u201d he said.<\/p>\n
In January, lawmakers \u2014 including senators from Mississippi and South Dakota \u2014 sent a letter<\/a> to the Biden administration urging the White House to work quickly with Congress to ensure payments continue for Medicare patients who use telehealth, \u201cespecially for rural and underserved communities.\u201d<\/p>\n
Maya Sandalow, a senior policy analyst for the Bipartisan Policy Center, a Washington, D.C.-based think tank, said lawmakers and policymakers are likely to consider a temporary extension of the payments rather than permanent changes.<\/p>\n
\u201cResearch is still coming out that covers more recent years than the acute effects of the pandemic,\u201d Sandalow said. The center expects to release policy recommendations in the coming months.<\/p>\n
Questions being considered include which kind of health care services are best for audio-only and video visits. Sandalow said researchers are also weighing how telehealth can \u201cexpand access to affordable, high-quality care while ensuring in-person options remain for patients.\u201d<\/p>\n
In North Dakota, Sanford Health\u2019s David Newman said virtual care is often the only way some of his patients in the western part of the state can get sub-specialty care, such as with behavioral health.<\/p>\n
Newman, an endocrinologist and Sanford\u2019s medical officer of virtual care, said 10% to 20% of his patients are seen virtually during the summer, as compared with about 40% in the winter months because \u201cthe weather can be so bad\u201d that roads are impassable.<\/p>\n
In winters past, Newman would sit around \u201cdoing nothing for a day\u201d because patients couldn\u2019t visit him. Now, he has a full clinic using telehealth technology.<\/p>\n
\u201cI tell my patients that if you can make a restaurant reservation or if you can order a pizza online, you can do a virtual visit,\u201d Newman said.<\/p>\n
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