Telehealth Practice

Encourage the Appropriate Use of Telehealth

In response to the COVID-19 public health emergency (PHE), CMS loosened its telehealth rules and expanded the types of telehealth services that are reimbursable by Medicare. According to HHS, telehealth utilization increased 63-fold, from approximately 840,000 in 2019 to 52.7 million in 2021.[i] These flexibilities have been critical for seniors, especially during the early months of the outbreak when in-person visits dropped dramatically.

Congress continues to recognize the importance of telehealth, including in the Consolidated Appropriations Act, 2021 (CAA), which permanently expanded the use of telehealth to provide mental health services. This expansion is noteworthy because of its permanence and because it does not subject these services to geographic restrictions, while also maintaining certain protections to guard against fraudulent activity (i.e., requirements that the clinician must have furnished an in-person item or service within the past six months prior to the first telehealth service). In addition, the CY 2024 Medicare PFS final rule finalized the implementation of telehealth-related provisions of the CAA, 2023, including the expansion of the definition of telehealth practitioners and the continued payment for telehealth services furnished by RHCs and FQHCs.

Although telehealth utilization has leveled off as in-person visits have rebounded, there has been a paradigm shift where the healthcare system now relies more on telehealth. Telehealth provided by a patient’s established provider can be a powerful tool for care delivery due to its potential to improve access to care for countless Americans. However, telehealth is particularly vulnerable to fraud and abuse and could lead to higher costs for patients. There is also limited data on the quality of telehealth.[ii] Additionally, there are concerns that telehealth could increase physician burden, which should be avoided as much as possible.[iii] ACOFP firmly believes that in-person care is the gold standard for care and that telehealth is a tool to improve care delivery when in-person care is not possible—not a silver bullet.

ACOFP is also concerned that the growth of telehealth could inadvertently disrupt existing physician-patient relationships and care coordination. Telehealth-only providers may have limited encounters with patients and may not appropriately coordinate with family physicians so that this trend could result in worsening medical conditions and poor health outcomes. ACOFP believes telehealth is best used for established patients, and the primary care physician should coordinate care for patients, including care furnished via telehealth.

Advocacy Positions:

• Require physicians who practice telehealth outside of interstate compacts to be licensed in the state in which they are practicing telehealth.
• Ensure accountability for out-of-state telehealth providers to safeguard patient safety and quality of care.
• Prioritize telehealth services for the patient’s primary care physician and ensure care is properly coordinated with the primary care physician.
• Continue to allow reimbursement for audio-only telehealth services in a manner that protects program integrity.
• Establish appropriate rules to curb fraud and abuse and protect patients from unnecessary charges.
• Use data and evidence to develop a telehealth coverage policy that ensures patients are receiving the highest quality care possible.
• Allow patients to use telehealth from their home by reforming or eliminating originating site requirements.
• Establish payment rates that reflect the resources and expertise necessary to deliver high-quality care via telehealth.
• Ensure that family physicians have sufficient resources to invest in new technologies to provide effective telehealth services.

[i] Centers for Medicare & Medicaid Services. New HHS study shows 63-fold increase in Medicare telehealth utilization during the pandemic. December 3, 2021. Accessed January 12, 2023. https://www.cms.gov/newsroom/press-releases/new-hhs-study-shows-63-fold-increase-medicare-telehealth-utilization-during-pandemic

[ii] Castellucci M. Telehealth explosion points to need for more research on quality of care provided. Modern Healthcare. June 18, 2020. Accessed January 12, 2023. https://www.modernhealthcare.com/safety-quality/telehealth-explosion-points-need-more-research-quality-care-provided

[iii] Based on a 2020 ACOFP member survey, 26 of respondents reported administrative burden associated with obtaining state licensures for using telehealth across state lines.