Telehealth Researchers Look to Sway Congressional Scorekeepers

Telehealth organizations are rushing to publish a sweeping study of the surge in virtual health-care visits over the past year in hopes of convincing congressional scorekeepers that letting seniors see their doctors remotely won’t break Medicare’s bank. 

The Center for Telehealth and e-Health Law is raising funds for a national study of telehealth use, made possible by a boom in remote doctor visits to help slow the spread of Covid-19 at clinics and hospitals. Researchers say the pandemic presents an opportunity to study data on potentially millions of telehealth visits to see how loosening restrictions on remote health-care would affect spending and patient care.

The goal, they say, is to catch the eye of the Congressional Budget Office and lawmakers to guide their work on telehealth legislation this year.

“CBO makes decisions based on the best-available information and our goal is to give them more concrete information to inform their decision-making,” said Yael Harris, vice president for health research and evaluation at the American Institutes for Research and one of the researchers preparing to work on the study.

How influential these researchers can be depends on whether Congress ends up acting on telehealth and if CBO is open to altering how it scores such legislation. The researchers are particularly looking for insight on how costs from telehealth — which makes it easier to access care and could result in more visits — are weighed against the potential savings from preventative care.

Harris and her counterpart, Jason Goldwater, a researcher with Index Analytics LLC, are gathering data from several large academic medical centers and hospitals that have been offering telehealth visits. Goldwater said he hopes to publish preliminary findings by the summer.

The pair and CTeL aren’t taking money from telehealth companies to avoid bias in the research or appearing as if the industry is bankrolling the effort, they said.

CTeL is a telehealth research institute created by hospital groups and the Mid-West Rural Telemedicine Consortium, a membership organization founded by hospitals to aid in providing interactive video for health-care providers.

Lawmaker Interest

When Covid-19 led doctors offices to close, the government temporarily approved Medicare payments for telehealth outside rural areas and added more than 100 new telehealth-eligible services.

The Centers for Medicare and Medicaid Services also allowed some health visits over the phone, waiving requirements for audio-visual technologies, and increased what it pays doctors for some telehealth visits to make them comparable to in-person visits.

As a result, Medicare beneficiaries used telehealth for 43.5% of their primary care visits in April 2020, compared to less than 1% in February 2020, before the start of the pandemic, according to the Department of Health and Human Services.

Rep. Anna Eshoo (D-Calif.), chair of the Energy and Commerce Health Subcommittee, recently said those temporary changes should be made permanent, and endorsed expanded use of telehealth where there are doctor shortages and for emergency and mental health care.

Permanent Medicare Telehealth Expansion Gains Lawmaker Support

Cost Questions

Cost could be a roadblock to making the changes permanent. CBO, tasked with telling lawmakers how legislation will affect government spending and revenue, has said the costs to Medicare for expanding telehealth services depend largely on the payment rates set for those services and whether a telehealth visit would substitute for other Medicare-covered services.

“Many proposals to expand coverage of telemedicine strive to facilitate enrollees’ access to health care,” CBO researchers wrote in 2015, in response to criticism of their work. “Therefore, such proposals could increase spending by adding payments for new services instead of substituting for existing services.”

Goldwater said his research will look at whether increased access to telehealth could reduce expenses by keeping people out of emergency rooms or helping them better manage their medications.

CBO is open to altering its projections, but usually only after there’s already widespread consensus among economists and researchers on a topic, said Philip Joyce, who was an analyst at CBO in the 1990s and wrote a book about the agency.

Joyce said industry groups and lawmakers regularly give CBO research or insight in hopes of shifting the congressional scorekeeper’s thinking, but the organization’s researchers have historically looked at them skeptically.

“I don’t think it’s all that mysterious about how to get something in front of CBO,” Joyce said. “The mystery is how to convince them that it’s true.”