Telehealth shutdown makes doctors’ visits more difficult for some Image By HPN Staff Key Points As of Oct. 1, Medicare recipients will no longer broadly qualify for telehealth reimbursement. The COVID-era flexibilities that had allowed telehealth for all beneficiaries will expire unless Congress acts. Providers may stop offering telehealth to Medicare patients (or cancel appointments), and patients may have to pay out of pocket for virtual visits. The expansion of access during COVID removed significant barriers, especially for those with disabilities or travel challenges. Congress failed to extend the program amid disputes over appropriations and spending. Past extensions added hundreds of millions (or billions) to Medicare costs, which makes permanent adoption controversial. Medicare recipients are no longer covered for telehealth visits as of Oct. 1. Telehealth Medicare flexibility was set to expire by Sept. 30 unless extended by Congress. Lawmakers failed to do so amid contentions over the passage of an appropriations bill. The subsequent government shutdown began the same day. The COVID-era program enacted during the first Trump administration relaxed restrictions on coverage for telehealth under Medicare, which, pre-COVID, was offered only for recipients in rural areas at designated facilities. Funding for a related COVID program, the Acute Care Hospital at Home initiative, which allowed for in-home hospital care, also expired on the same date. The American Telemedicine Association (ATA) sent letters to President Trump and Congressional leaders, asking for both programs to be reinstated, as well as for a retroactive telehealth reimbursement provision. Why it matters Expiration of program funding restores pre-COVID restrictions — meaning providers will no longer be compensated for offering telehealth services to most Medicare patients. Telehealth may still be available, but patients will need to pay out of pocket for it, and several doctors are cancelling telehealth appointments. The expanded telehealth provisions proved extremely popular among Medicare recipients, due to the ease of seeing a doctor without the trouble of going to the office. Telehealth also reduced barriers to care for those with disabilities. Before COVID, telehealth usage among that population was low, but rose dramatically during the pandemic, from roughly 840,000 visits in 2019 to nearly 52.7 million in 2020. Usage of telehealth by Medicare beneficiaries has declined since 2020 but remains higher than pre-pandemic levels. The program has also enjoyed bipartisan support in Congress and has been extended yearly since its inception, until now. Both Republicans and Democrats had proposed funding bills that included an extension of Medicare telehealth flexibilities, but neither gained traction in the days leading up to the shutdown. More context While popular, the extension of telehealth coverage to all Medicare recipients came at a cost. According to the Congressional Budget Office, extending telehealth flexibilities cost $663 million in 2023, and the 2024 extension an additional $2.4 billion. This cost is one reason why the program has been subject to yearly Congressional reauthorization. Some, including the ATA, have advocated for making the program funding permanent. “President Trump has been the most transformative president in history for the telehealth and virtual care community, having broken down barriers and driven unprecedented adoption,” said Kyle Zebley, executive director of ATA Action and senior vice president of public policy at the ATA. “No one is in a better position to end this cycle of short-term thinking and make these vital telehealth flexibilities permanent and cement his legacy of healthcare modernization and innovation. "Others, however, have raised concerns in the past over the program, suggesting telehealth expansions may contribute to overuse and excess costs. A report by the Paragon Health Institute recommends that Congress investigate whether telehealth expansion has resulted in costly overutilization before making the funding permanent. SUGGESTED STORIES Many skip doctor visits and prescriptions, new data shows More than a third of Americans are skipping or postponing doctor visits and other needed health care due to high cost, according to recent polling from the Kaiser Family Foundation (KFF). In a related trend, more than 20% of patients have not fi Read more Telehealth appointments can boost impact of weight-loss drugs, study finds Regular telehealth appointments for obesity patients could significantly improve the effectiveness of weight-loss drugs like Ozempic and Wegovy, which are often prescribed online without follow-up, new research has shown. 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Many skip doctor visits and prescriptions, new data shows More than a third of Americans are skipping or postponing doctor visits and other needed health care due to high cost, according to recent polling from the Kaiser Family Foundation (KFF). In a related trend, more than 20% of patients have not fi Read more
Telehealth appointments can boost impact of weight-loss drugs, study finds Regular telehealth appointments for obesity patients could significantly improve the effectiveness of weight-loss drugs like Ozempic and Wegovy, which are often prescribed online without follow-up, new research has shown. That could be significant when it comes to lon Read more
Senate considers bill to tackle Medicare Advantage upcoding costs The U.S. Senate is considering a bipartisan bill that proponents say will improve the way Medicare Advantage (MA) plans evaluate patients’ health risks, reduce overpayments and eliminate incentives for overcharging. It could save the federal government Read more
