67 million Medicare recipients face 'chaos' if Congress cuts telehealth benefits

By Jessica Hall

Elderly and disabled patients could miss out on healthcare services unless an extension is passed before the end of the year

Medicare beneficiaries' access to telehealth services will expire at the end of the year unless Congress acts, and public-health experts say that doing away with video-enabled medical care would lead to "chaos" in the healthcare system relied on by 67.4 million Americans.

About 5% of Medicare's overall outpatient visits are currently conducted via telehealth, according to Ateev Mehrotra, a professor at Brown University's School of Public Health. Telehealth usage was as high as 42% during the height of the COVID-19 pandemic, he added.

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The types of medical appointments carried out via telehealth include mental-health visits, dermatological screenings and conversations with a primary-care doctor about cold or flu symptoms or about getting physical therapy.

"If the rules were to expire, many people would be devastated. People are going to be frantic," Mehrotra told MarketWatch in an interview. "Anxiety is increasing by the day because the year-end is approaching and Congress hasn't passed these extensions."

He added: "It's going to be chaos. It will confuse a lot of people."

The House Committee on Energy and Commerce advanced the Telehealth Modernization Act of 2024 out of committee last week. The two-year extension being proposed is similar to other proposals advanced in May by the Commerce Committee's health subcommittee and the by House Ways and Means Committee.

"These provisions play an essential role in expanding access to care for patients regardless of geographic location and allow a broader range of healthcare professionals to provide telehealth services," said ATA Action, the advocacy arm of the American Telemedicine Association.

Even if Congress fails to pass the proposed measure, Medicare recipients in rural areas will still be able to use telehealth services, but only if they are accessing the technology from a medical building such as a doctor's office or a hospital to speak with a provider located elsewhere.

All Medicare recipients will also still be able to use telehealth for three conditions: stroke, mental illness and substance-abuse disorder.

If one of the proposed measures passes, access would be extended for two years. But because telehealth is popular with consumers, the problem would be funding it, Mehrotra said.

"Telehealth's main strength is convenience. When you make it more convenient, people are going to use it more. Its strength and its Achilles' heel are one and the same," he said.

More telehealth usage leads to fewer emergency-department visits and better medication management among patients, but there's still an overall cost increase for Medicare, Mehrotra said.

For example, Mehrotra told Congress in testimony in March 2024 that studies have found a 2.2% increase in telehealth visits per patient per year. A total of 83% of these visits were instead of in-person visits. The increased access to telehealth led to a higher cost of $248, or a 1.6% increase in healthcare spending, per capita, Mehrotra said in his testimony. Meanwhile, a 2024 study in JAMA put the higher cost of increased usage of telehealth at $164.99 per beneficiary.

"Instead of going back in time and ending telehealth services, we should do education with providers on the best ways to utilize telehealth. We should figure out what's working and tweak the system to make it more affordable. It would have a really adverse effect on the Medicare population if services were to end," said Jessica Wagner, chief operating officer of RXNT, a healthcare-software company.

Wagner said there will always be a need for "room-to-room" medical treatment at a doctor's office, but that telehealth plays an important role in expanding healthcare access before health issues become emergencies and in providing access to specialists who may be too far away for patients to travel to.

The Centers for Medicare & Medicaid Services said telehealth is an example of creating greater flexibility and accessibility for Medicare beneficiaries but declined to speculate on the future of the rules.

"We want those who rely on Medicare to continue receiving quality care and services from their doctors without having to travel to a hospital or clinic. Promoting access to telehealth in this way also promotes equity, as individuals in rural and other underserved areas may have trouble transporting themselves to an in-person visit or may have worse access to broadband," a CMS spokesperson said in an emailed statement.

-Jessica Hall

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09-25-24 0932ET

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