During the COVID-19 pandemic, the use of telehealth services exploded. In response, Medicare expanded its coverage of things like doctor's appointments over the internet, also known as telehealth.
But that coverage will expire at the end of this year unless Congress takes action.
Health care providers said the loss of telehealth visits would be devastating for Medicare patients and the area at large.
COVID-19 changes telehealth availability
During the pandemic, the federal government declared a public health emergency.
That made it easier for patients, specifically Medicare patients, to receive care virtually. The Centers for Medicare & Medicaid Services was able to reimburse health care providers for telehealth services at the same rates as in-person visits.
"Right now, a Medicare patient can sit in their home and they can receive care, via telehealth, from any of their Medicare billing providers," said Marie Mongeon, vice president of policy for the Community Health Center Association of New York State. The association represents 80 health centers across the state.
The issue, Mongeon said, is that telehealth flexibility and reimbursement rates weren't set in stone.
Extension ending without congressional action
When the coronavirus public health emergency officially ended last year, Congress passed legislation to extend telehealth reimbursement.
That extension expires on Dec. 31.
While behavioral health telehealth visits —appointments having to do with mental health — have been made permanently reimbursable, any other medical appointment has not.
Mongeon said if Congress doesn’t extend telehealth reimbursement before the Dec. 31 deadline: "Health centers, community health centers, specifically, will no longer be able to provide medical telehealthcare to their Medicare patients."
Instead, Medicare recipients would have to go in person.
"What this really means is we risk that patients aren't able to continue receiving care the way that they want to receive care," Mongeon said.
Telehealth 'transformative' to rural health care
For the last few years, Mongeon said, patients have enjoyed more access and choice to when, how, and where they can access doctors and medical care.
Ray Babowicz, director of communications and strategic partnerships at Community Health Center of the North Country, said that’s been transformative in rural health care.
The center operates four sites in St. Lawrence and Franklin counties, seeing about 15,000 patients annually.
"Telehealth is one of the bright spots that came out of the pandemic mess," he said. "It really revolutionized things for us, especially in our rural areas, like in the North Country."
He said virtual appointments get around challenges like far distances, bad weather, or mobility challenges.
"You can still have these telehealth visits and keep on schedule with what your physician wants, without having to take the risk of leaving your house if it's not necessary," Babowicz said.
He said telehealth visits make a lot of sense for routine, relatively short check-ups on chronic issues like diabetes, or high blood pressure, which Medicare patients and seniors are often dealing with.
"We've had great success with it across all our disciplines," Babowicz said. "We've seen a great drop in no-show rates, for example."
If the telehealth option isn't there, he said things will change again.
"We’ll go back to people missing their appointments for unnecessary reasons," he said. "Worst-case scenario, they end up at an emergency department, which is what we're trying to prevent to begin with."
Time is running out ... what comes next?
Mongeon said if flexibility is not extended for medical telehealth appointments by Dec. 31 through congressional action, we’ll go back to the status quo from 2019.
"This means that for community health centers ... they cannot be paid for delivering telehealth services if those telehealth services are medical telehealth services," she said.
With just a few weeks before the deadline, it's unclear whether Congress will act before then.
Mongeon works in advocacy and said New York’s congressional delegation is supportive of extending telehealth flexibility, and that this seems to be a place of bipartisan overlap.
"To the credit of New York's congressional representatives, we have really widespread bipartisan support for extending the Medicare telehealth exemptions. We've heard that that support exists," Mongeon said.
She said Republican Rep. Elise Stefanik has expressed support for telehealth, and so has Democratic Sen. Chuck Schumer.
Schumer held a news conference about the so-called "telehealth cliff" in early December in Gloversville and warned that more than 200,000 upstate New York seniors could lose coverage.
He said telehealth appointments "allow people who can’t get to a hospital to get good health care. So, it’s convenient for them. You don’t have to take a day off of work. You don’t have to drive 50 miles and wait in the hospital.”
Other effects and long-term access to telehealth
If Medicare patients can’t be seen via telehealth appointment, some providers may stop offering them for all patients, Mongeon said.
"It becomes a question of, do you have the infrastructure to support telehealth, period?"
If all Medicare patients are suddenly required to come into the office, she said: "I think some health centers would have to look at how they are able to support the provision of that care, because, really, at the end of the day, it needs to dovetail with demand."
Telehealth visits can’t be justified forever by "extension," said Babowicz, especially for seniors, who, in many ways, they are most advantageous for.
"Anything that's not permanent or long term, it makes it harder for you to invest," he said.
"Business is business, right? You're willing to invest millions of dollars in a service line, you need to know that it's not going to be yanked out from underneath you."
Currently, two pieces of legislation on the federal level would, if passed, make telehealth flexibilities permanent: the Connect for Health Act and the Modernization for Telehealth Act.
Mongeon and Babowicz are particularly supportive of the second, which would legitimize audio-only telehealth calls, which would have a big impact for rural communities without broadband access.