The Federal Government’s Complicated Relationship with Telehealth

As part of the COVID-19 Public Health Emergency, or PHE, which officially ended earlier this month, the federal government gave healthcare providers considerable flexibility to continue practicing via telehealth by dropping restrictions on its use.  

Congress extended some of these flexibilities until Dec. 31, 2024, providing federal agencies of jurisdiction time to analyze the full impact of telehealth and Congress time to consider whether and how these waivers will be extended. Importantly, it was also done in part to add more evidence to the growing but inadequate pool of virtual care research. 

In addition, just last week, the U.S. Department of Health and Human Services (HHS) released an official notification stating that with the end of the PHE, healthcare providers will have 90 days to transition back into compliance with the telehealth rules they operated under prior to the pandemic.

However, two days before the PHE expired, the Drug Enforcement Administration (DEA) extended telehealth flexibilities that enable clinicians to virtually prescribe controlled medications to their patients for another six months. That was going to end with the PHE’s termination.

According to comments submitted to the DEA by the American Telemedicine Association, failure to extend these pandemic-era flexibilities, thereby once again requiring patients to be evaluated in-person by a doctor to receive prescriptions for certain controlled substances, would miss the point entirely of the gains made by telehealth during the pandemic – and reinstate barriers to care. 

This interplay of positions on the use of telehealth between Congress and multiple federal agencies demonstrates the complicated relationship the feds seem to have with the provision of telehealth services.

Now, let’s go back to that growing yet inadequate pool of virtual care research I mentioned earlier, and briefly investigate a couple of primary claims about expanded telehealth use and what the research shows.

Before the DEA extended its pandemic flexibilities, the agency had actually planned to do the exact opposite of what it wound up doing, and increase restrictions on virtual prescribing of controlled substances under the proposition that more safeguards were needed to prevent online over-prescribing of controlled medication.

However, according to a recent study conducted by the National Institute on Drug Abuse, expanded use of telehealth services during the pandemic was shown to reduce the risk of opioid overdoses, while increasing opioid use disorder treatment, access, and adherence.

Policymakers also expressed worry that expanded telehealth during the pandemic was being utilized inappropriately, leading to an increase in emergency department usage. But once again, the research proved otherwise.

According to a study report released last month in the Journal of the American Medical Association (JAMA), researchers examined data from nearly 14,000 family physicians with about 13 million patients and found that patients of doctors who used virtual care for over 20 percent of their patient visits went to the ED less often than those whose doctors held fewer of their appointments virtually.

Accordingly, the researchers concluded that expanded telehealth access can actually outweigh face-to-face interaction when it comes to quality of care, wholly refuting the purported connection between expanded telehealth services and increased ED utilization.

It remains unclear how long temporary telehealth flexibilities will be extended, if or when the DEA will issue a final rule on virtual prescribing of controlled substances, and whether Congress will act to finalize the telehealth flexibilities it extended through the end of next year.

The one thing that does seem clear is that, in order to simplify the complex relationship our governing bodies have with telehealth, they need to spend more time diligently evaluating pertinent research findings and considering comments from patients and providers across the healthcare spectrum to draw appropriate, substantiated conclusions on the proper regulatory path forward.