• AAFP Continues Telehealth Push With Senate Testimony

    Academy Member Delivers Detailed Recommendations to Finance Committee

    May 26, 2021, 1:25 p.m. News Staff — As lawmakers consider how to solidify telehealth policy flexibilities introduced during the COVID-19 public health emergency, the Academy has again offered detailed recommendations emphasizing virtual care’s strengths as part of comprehensive, continuous primary care.

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    “I want telehealth to be a tool in my toolbox, and I want to choose when and how to deploy it based on my clinical judgment, not based on whether I will get paid,” AAFP member Kisha Davis, M.D., M.P.H., of Gaithersburg, Md., told the Senate Finance Committee on May 19.

    Davis, representing the Academy at a hearing titled “COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned,” delivered live remarks, answered questions and entered extensive written testimony into the record.

    The message: Medicare and Medicaid telehealth policy must increase equitable access to health care; promote high-quality, comprehensive, continuous care; and lessen physicians’ administrative burdens.

    “I have experienced the impact of the COVID-19 pandemic and resulting federal policy changes firsthand as a front-line physician, and I have had the opportunity to observe them on a broader scale,” said Davis, vice president of health equity at the value-based care network Aledade and a former White House fellow who last month was named to the Medicaid and CHIP Payment and Access Commission. She also is a member of the AAFP’s Commission on Federal and State Policy.

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    “Telehealth can enable timely, first-contact access to care and supports physicians in maintaining long-term, trusting relationships with their patients, both of which are central to continuity of care,” she added, citing the Joint Principles for Telehealth Policy that the Academy developed in partnership with the American Academy of Pediatrics and the American College of Physicians. “Allowing physicians to provide telehealth services from their home enables them to extend their availability beyond traditional office hours for patients who, due to work or child care constraints, are unable to take time off work for an appointment. This not only advances equitable access to care but also can prevent unnecessary trips to urgent care or the emergency room.”

    The positive effects aren’t limited to patients. Updating telehealth policy is an opportunity to safeguard the health care workforce, Davis testified.

    “Telehealth can also be a tool to help alleviate physician burnout by facilitating better work-life balance,” she said. “One example: Some employers allow physicians to be on ‘telehealth duty’ in the period leading up to and following their maternity leave.”

    The same day as the Senate hearing, the Kaiser Family Foundation published a telehealth issue brief complementary to the AAFP’s testimony. Centered on Medicare’s telehealth coverage (based on data in the CMS Medicare Current Beneficiary Survey’s Fall 2020 COVID-19 Supplement), it found that 45% of Medicare beneficiaries (about 14.9 million people) said they’d had a telehealth visit since July 2020, with more Black patients than white using the modality but also reporting more limited telehealth availability than white or Hispanic patients.

    The Academy’s latest recommendations take aim at that discrepancy and similar recently documented challenges to telehealth equity, calling for CMS policy that

    • permanently removes geographic and originating site restrictions to ensure that all Medicare beneficiaries can access telehealth care at home;
    • requires Medicare to cover audio-only evaluation and management services beyond the public health emergency;
    • permanently covers telehealth services provided by federally qualified health centers and rural health clinics and ensures adequate payment;
    • monitors the impact of telehealth on access and equity by ensuring that data collection and evaluation include information about race, ethnicity, gender, language and other key factors; and
    • invests in infrastructure to promote digital health equity.

    Additionally, the Academy’s testimony said that post-PHE telehealth should

    • enhance the physician-patient relationship rather than disrupt it and incentivize coordinated, continuous care provided by the medical home;
    • adopt payment models that support patients’ and clinicians’ ability to choose the most appropriate modality of care and ensure appropriate payment for care provided;
    • mandate Medicaid coverage of all vaccines recommended for adults by the Advisory Committee on Immunization Practices;
    • permanently allow physicians to provide direct supervision and teaching services via telehealth to expand access to primary care services and increase training opportunities;
    • reduce the volume of prior authorization requirements to decrease unnecessary administrative burden on physicians;
    • grant HHS the authority to waive reporting and other administrative requirements for the Quality Payment Program and Medicare Shared Savings Program in future public health emergencies without rule-making to enable physicians to focus on patient care during emergencies; and
    • restore Medicare and Medicaid policies that facilitate physician-led, team-based care models to safeguard patient safety and maintain access to appropriate, high-quality care.

    That last item — in answer to CMS having waived requirements for physician supervision in Medicare, Medicaid and the Department of Veterans Affairs system during the public health emergency — is the AAFP’s only significant call to reverse a telehealth change stemming from the pandemic. It’s in line with the Academy’s position that patients are best served by physician-led teams.  

    “While certain flexibilities during the PHE addressed the historic nature of the pandemic, flexibilities to loosen supervision requirements should be restricted by Congress to ensure continuity of care and high-quality, accessible health care for all patients,” Davis testified.

    The May 19 testimony echoed and updated the Academy’s message to House members this past March when that chamber’s Committee on Energy and Commerce’s Health Subcommittee convened a hearing titled “The Future of Telehealth: How COVID-19 Is Changing the Delivery of Virtual Care.”

    The AAFP has made telehealth flexibilities a cornerstone of its lobbying efforts over the past year. The topic was central to the messaging that Academy members brought to legislative meetings during the AAFP’s annual Family Medicine Advocacy Summit, which also took place May 19.