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The Unclear Future of Telehealth in the U.S.

Here in the U.S., we’ve seen a rapid expansion of telehealth services during the COVID-19 pandemic. During the height of the pandemic, over 32 percent of total outpatient visits were occurring via telehealth. These services became an essential tool that allowed patients to access the healthcare services they needed in a safe manner. Many important mental health services were also provided online via teletherapy.

Telemedicine is the delivery of health and health-related services via telecommunication and digital communication to facilitate long-distance care. This includes medical care, mental health care, patient education, health information services and self-care. Mental health and substance use disorder treatment have been the most common types of care sought using telemedicine.

Utilization of telehealth services began to decline in February of 2021 and now appears to have stabilized at around 13 to 17 percent of total outpatient visits. However, even this reduced level is still 38 times higher than before the pandemic, when the overwhelming majority of outpatient visits happened in person.

Based on these utilization rates, it’s clear many patients find telehealth services useful. Providers are also supportive of continuing the expanded use of telemedicine. According to a recent study by the American Medical Association and the COVID-19 Healthcare Coalition, 68 percent of physicians supported increasing the use of telehealth in their practice and 71 percent said their organization’s leadership was motivated to do the same.

Despite the support from consumers and medical professionals alike, utilization rates may not stay at this level in the future. That’s because multiple emergency measures related to telehealth’s expansion and coverage are currently scheduled to end.

Telehealth and the Public Health Emergency (PHE) Declaration

On January 27, 2020, the federal government declared COVID-19 a public health emergency (PHE). Declaring a PHE triggers emergency powers that permit assistance to state and local governments, suspend or modify certain legal requirements and allow funds to be spent to address the public health emergency. PHEs have previously been declared for events such as wildfires, hurricanes, the opioid crisis and the Zika virus outbreak.

For COVID-19, declaring a PHE allowed the federal government to take steps that make it easier to provide and receive health care. One example includes receiving healthcare via telemedicine. Before the pandemic, licensed clinicians were required to hold a valid license in the state where their patient was located. Authorized providers were also required to make an in-person evaluation to prescribe certain controlled substances. Both of those requirements were lifted with the PHE declaration, giving providers more flexibility to use technology to deliver services across state lines depending on rules set by state and federal policies.

The End of Telehealth Flexibility?

The measures under a PHE are temporary and subject to change, with PHE declarations expiring automatically after 90 days. The Department of Health and Human Services has renewed the PHE for COVID‑19 seven times so far, with the most recent PHE declaration effective through January 16, 2022. In the short term, it’s likely the PHE will be renewed again. In the long-term, the role of virtual care in the U.S. healthcare industry after COVID-19 is still being defined.

In Congress, the proposed bipartisan Cures 2.0 bill includes provisions that would make telehealth services available permanently even after the COVID-19 PHE expires. The bill includes several measures to make it easier for providers to receive reimbursement from Medicare for telehealth services and would remove Medicare’s previous rules requiring patients to live in a rural area and be in a doctor’s office to qualify for telehealth services.

Most experts agree telehealth will continue to exist in some form after becoming so common and highly utilized. However, it’s unclear what aspects of telehealth will be permitted by the federal government when the PHE eventually ends, including how much of these services will be reimbursed.

[Jamie Becker is the LHSFNA’s Director of Health Promotion.]

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