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Key GOP senator endorses permanent telehealth provisions

Virtual care is surging during pandemic

Sen. Lamar Alexander, R-Tenn., shown here in May, wants Congress to authorize Medicare and Medicaid to continue to pay for remote doctor and emergency care.
Sen. Lamar Alexander, R-Tenn., shown here in May, wants Congress to authorize Medicare and Medicaid to continue to pay for remote doctor and emergency care. (Andrew Harnik/AP/Pool)

Senate Health, Education, Labor and Pensions Chairman Lamar Alexander on Wednesday called on Congress to make permanent two temporary telehealth changes enacted in response to the COVID-19 pandemic.

Alexander called for Medicare to permanently pay doctors for telehealth visits regardless of the patient’s location, and to keep in place new types of telehealth services, such as emergency room visits, eligible for Medicare and Medicaid reimbursement.

Earlier this month, the Tennessee Republican called for preserving gains made through telehealth in a white paper focused on preparing for future pandemics.

Telehealth exploded once the coronavirus shuttered doctors’ offices across the nation, turbocharging the shift to virtual care. Congress responded by allowing the Centers for Medicare and Medicaid Services to waive a series of wonky restrictions on telehealth during the public health emergency. For instance, one provision suspended the so-called originating site rule restricting patients from using telehealth in their homes.

“We ought to stop and think for a moment about how significant a change this is and whether it would have even possibly happened without this crisis,” Alexander said in a hearing on telehealth Wednesday.

Alexander also noted the impact of relaxing security rules under the Health Insurance Portability and Accountability Act, or HIPAA, to allow patients to use everyday platforms like FaceTime to talk to their doctor. But privacy concerns make the issue dicey.

“The question of whether to extend the HIPAA privacy waivers should be considered carefully,” he said. “There are privacy and security concerns about the use of personal medical information by technology platform companies, as well as concerns about criminals hacking into these platforms.”

Telehealth has plenty of supporters in Congress, but finding offsets for the increase in spending that could come with an increase in health care services remains a hurdle. The increase could likewise translate to higher premiums. Blue Cross Blue Shield of Tennessee Chief Medical Officer Andrea Willis said the company was still unsure of the impact its own telehealth expansion would cost in the short term.

“We’re still accumulating data so we don’t really know that yet,” she said. “But we do think that we’re going to gain efficiencies. We’re going to keep people out of the ER that didn’t need to be there. Then we think people are going to get care they may have foregone, so down the line we think that it will save money.”

Other committee members pushed for the preservation of other telehealth waivers, like allowing services conducted by telephone and permitting telehealth visits across state lines. The committee also recognized the need for more broadband in rural areas where internet and phone service is limited.

Alexander indicated the changes could come in a legislative package focused on future pandemics.

“Any of the policy changes that are going to be made permanent need to be made permanent this year, and it might be part of a package of other other subjects,” he told CQ Roll Call. “For example, whatever we do about manufacturing of vaccines, whatever we do about data collection.”

Katherine Tully-McManus contributed to this story.

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