Trump administration aims to keep telehealth revolution here to stay
This article first appeared in USA Today on July 31, 2020
The COVID-19 pandemic has forced healthcare providers around America, and across the world, to adapt in real time, from reorganizing hospitals to devising treatment protocols as rapidly as possible. But one of the most fundamental transformations has applied to all of healthcare, not just COVID-19 testing and treatment: the meteoric rise of telehealth.
In just weeks, Americans went from using telehealth — carrying out medical appointments over virtual connections rather than in person — in a relatively narrow set of circumstances to making it one of the most common ways to receive healthcare. This spring, from March to April, the number of patients using telehealth services in traditional Medicare increased from roughly 13,000 a week to over 1.5 million a week.
In February, just 0.1% of primary care visits covered by traditional Medicare were done via telehealth. By April, it was 43.5% — more than a 400-fold increase.
Bold action by President Trump and his administration made this explosive growth possible. The Centers for Medicare & Medicaid Services dramatically expanded Medicare coverage for telehealth, doubling the number of services that can be provided through telehealth to include everything from emergency department visits to eye exams and therapy services.
HHS’s Office for Civil Rights provided flexibility to allow health care providers to do telehealth visits immediately using popular communication apps like FaceTime and Skype, without any additional paperwork and without risking penalties for HIPAA violations. HHS’s Office of Inspector General provided flexibility for healthcare providers to reduce or waive cost-sharing for telehealth in federal programs, so that providers can limit costs to patients using telehealth.
These changes are largely emergency exceptions to the existing federal regulations around telehealth — regulations that explain much of why telehealth hadn’t taken off before the pandemic.
For most services before the pandemic, Medicare simply didn’t pay for telehealth unless you lived outside of a metropolitan areas or in a rural area with a shortage of a certain type of providers. Believe it or not, this meant that you could live three hours north of Duluth, Minnesota, or three hours south of Phoenix, Arizona, by the Mexican border, and still not be eligible for telehealth coverage unless there was an official shortage of the type of healthcare provider in your area.
In addition, telehealth services in Medicare and Medicaid typically haven’t been available in your home. Because of concerns around fraud, patients still had to travel to a nearby healthcare facility, rather than receiving services from their home, and providers had to do the visit from an office, too. Of course, it’s far more convenient just to be able to do the visit from home, especially for patients in rural areas or without reliable access to transportation.
The Trump administration has been working to address these challenges long before the pandemic. In 2018, we created two new ways for Medicare to pay providers specifically for brief virtual visits and for assessments of electronically transmitted images. Before this change, a phone or video check-in that a physician did with a patient was not something Medicare could pay for separately.
Some of what’s needed to make telehealth more broadly accessible isn’t just regulatory flexibility, but investment: We’re working with the Federal Communications Commission and the Department of Agriculture to expand rural broadband and other infrastructure necessary for telehealth. The Trump administration has invested in making telehealth accessible to underserved communities, including through community health centers funded by HHS’s Health Resources and Services Administration. In 2018, 43% of health centers offered telehealth services. It’s now more than 90%, and about half of health center visits during the pandemic have been virtual.
We’re now aggressively looking at how to make the telehealth revolution a permanent part of American medicine. The past several months will give us experience and data that can inform regulatory reforms. In many cases, Congress needs to make statutory changes, and we’re working with members of both parties on that already.
It’s worth being frank about why so many barriers to telehealth exist in the first place: In many cases, well-meaning anti-fraud and privacy measures make it more difficult than it needs to be. There’s a reluctance to let Medicare pay for more telehealth on the grounds that this will drive up healthcare utilization, straining our healthcare system and the program’s budget.
That kind of static thinking is one of the biggest problems in American healthcare. We shouldn’t stand in the way of delivering necessary healthcare services in the most convenient way possible — especially as our healthcare system shifts toward paying for outcomes rather than procedures. We can safely protect privacy while fixing regulations so that they don’t stand in the way of coordinated, patient-centered care.
We all know that telehealth can’t always replace in-person care. But giving patients and providers the flexibility to decide on the right mix of the two will come to represent the new gold standard for care and a key part of President Trump’s healthcare vision: an affordable, personalized system that puts you in control, provides peace of mind and treats you like a human being, not a number.
Alex M. Azar II is U.S. Secretary of Health and Human Services.