Updates on Federal Telehealth Reform Efforts

The use of telehealth skyrocketed during the COVID-19 pandemic as consumers were forced to find alternatives to seeing doctors in person. According to the Office of the National Coordinator for Health Information Technology (ONC), telemedicine use among office-based doctors increased nearly six-fold after the start of the pandemic.

This movement toward virtual healthcare was largely viewed as successful, with more than 80 percent of doctors claiming that they planned to continue using telehealth even after the pandemic ended, according to a survey conducted by the ONC.

Nevertheless, we’ve heard lots of talk about telehealth policy from federal lawmakers, but action to make these policies permanent has been sparse, creating much uncertainty around this policy at the federal level.

As we approach the end of 2023, I thought I’d briefly review where things stand in Congress on the issue of telehealth and how we got here.

One of the areas of telehealth use that flourished during the pandemic was the prescribing of controlled substances, which was prohibited via telehealth prior to the public health emergency (PHE). It also serves as a good example of how far telehealth has come, or not come.

According to a recent study, expanded telehealth use reduces the risk of opioid overdoses and improves access to opioid use disorder treatment. But following the pandemic, the Drug Enforcement Agency (DEA) unfortunately planned to revert to its pre-pandemic policy of prohibiting virtual prescribing of these and other controlled substances.

Correspondingly, in May, the DEA only reversed its proposed ban on telehealth prescriptions of controlled substances after receiving nearly 40,000 comments arguing against the prohibition.

Instead, the DEA’s temporary rule extended pandemic flexibilities in prescribing controlled substances until Nov. 11, just 9 days ago. The rule also allotted an additional one-year grace period, to November 2024 to give providers time to meet an in-person exam requirement for controlled substance prescribing.

Did this do enough though? It seems like regulators simply kicked the ball a bit further down the road and will have to address the issue again in a year.

To their credit, last month the DEA and U.S. Department of Health and Human Services (HHS) announced they would be extending the temporary prescribing flexibilities for controlled substances through the end of 2024. But still, this is another band-aid for a problem that needs a permanent fix.

Apart from prescribing, the following month, in June, the CONNECT for Health Act of 2021 was introduced in Congress, which would codify COVID-era virtual care flexibilities by permanently removing geographic restrictions on telehealth, expanding originating sites to include the home, and eliminating the six-month in-person visit requirement for mental healthcare via telehealth.

The bill was first introduced in the Senate, with 60 bipartisan cosponsors, and soon after, similar companion legislation was introduced in the House. However, neither bill has moved since that time, nor does either bill have a place on any congressional to-do lists before year-end.

We now arrive at last Tuesday, when a Senate subcommittee on healthcare issues met for a hearing on the future of telehealth. During the hearing, subcommittee members again conveyed bipartisan support for making certain telehealth flexibilities permanent, including those regarding prescriptions of certain controlled substances.

Proponents of making these changes permanent emphasized their utility in enhancing access to care and stressed that action sooner rather than later is vital to prevent uncertainty in the industry, while others expressed concern that more flexibility could give certain providers an unfair competitive advantage. But again, no action outside of extending cutoff dates.

A senior vice president at the American Telemedicine Association has been quoted as claiming that 2024 is “shaping up to be the Super Bowl for telehealth.” To that, I say, we’ll have to wait and see whether it’s a dud or one for the ages, but with so much at stake for providers, patients, and the industry at large, I’ll be watching closely regardless and suggest you do the same.