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Throughout the course of the past year, with the pandemic and the subsequent shutdowns, quarantines, and increased public health risks, telehealth experienced an unprecedented boom. Offering a safe and more convenient way to engage with healthcare providers from the comforts of home, many are growing used to this new way of care.

During the heat of the pandemic and quarantines, the Centers for Medicare and Medicaid Services (CMS) took swift action to adopt temporary telemedicine approvals for eligible participants of those programs, including audio-only coverage. At the time, Americans were told to stay home, creating a dilemma for those in need of health and wellness services. Telehealth provided a safe way to engage, and CMS made sure those appointments would continue to receive authorized coverage. And while the widespread adoption began in response to an emergency, it continues to be a viable and popular method today with audio-only visits further expanding access to care for those that lack advanced forms of technology.

With the debate regarding expanding audio-only healthcare coverage beyond the context of the pandemic heating up, let’s take a look at what the potential expansion of this new form of care would mean for consumers.

1. Legislative Change at a Large Scale that with Expand Audio-Only Telehealth Coverage

Prior to the COVID-19 pandemic, coverage of telehealth services under traditional Medicare was extremely limited. In 2016, only 0.3% of Part B Medicare beneficiaries used any variation of telehealth services. During the Public Health Emergency (PHE), the CMS expanded the coverage of telehealth services by Medicare and Medicaid plans dramatically. Between the Summer and Fall of 2020, one in four Medicare beneficiaries had a telehealth appointment. A portion of these visits, especially in rural communities, was audio-only telehealth in which the doctor and patient only spoke rather than saw each other through their screens.

According to various datasets, audio-only telehealth usage throughout 2020 reached sky-high rates. Behavioral health visits saw some of the most drastic distinctions. Only 22.8% of those visits happened in a traditional office setting. Almost 14% took place via video call, and more than 63% occurred over the phone. 

This expansion in coverage will expire at the end of the PHE, driving many to advocate for long-term policy changes surrounding audio-only telehealth.

US Representatives Jason Smith (R-MO) and Josh Gottheimer (D-NJ) introduced on May 20th the Permanency for Audio-Only Telehealth Act (HR 3447), which advocates for the expansion of audio-only coverage past the PHE. Additionally, the bill aims to remove geographic and originating site restrictions on coverage, further expanding its reach.

With the bill placed in front of Congress, consumers participating in Medicare and Medicaid must be aware how the potential for the extension and expansion of audio-only telehealth after the close of the PHE will affect their future provider visits.

2. Increase in the Accessibility of Coverage for Those Who Struggle with More Traditional Avenues of Care

Supports of the expansion of audio-only healthcare coverage following the end of the PHE stress the importance of expanding access to care for underserved areas that lack traditional means of meeting with their providers. The Healthcare Leadership Council, Better Medicare Alliance, and many other reputable organizations have been very vocal in their support of state and federal legislation enhancing audio-only telehealth coverage, saying it improves access to care.

Audio-only healthcare has seen marked improvements in populations that struggle attending in-person visits or lack the technology necessary to make video calls. Rural, low-income, and senior patients comprise the demographics that have been shown to benefit the most from this expansion in coverage.

The American Medical Association (AMA) also weighs in on the audio-only telehealth conversation with suggestions for potential expansion. Officials strongly urged CMS to continue supporting the audio-only options.

Audio-only telehealth doesn’t necessarily offer the visual connection. But as the AMA points out, a phone or voice connection may be the only connection residents have in rural or low-income areas with limited broadband infrastructures. Officials also predict the need for these types of remote-centric engagements won’t end when the Public Health Emergency (PHE) does.

Telehealth isn’t intended to replace traditional in-person healthcare. However, in scenarios like the recent public health crisis, digitally connecting with physicians is the better alternative to not receiving care at all.

3. The Reduction in Face-to-Face Contact May Further Fracture the Patient-Provider Relationship

While telemedicine satisfies an immediate need for healthcare today, many opponents insist these accommodations should remain temporary solutions. Healthcare, according to many health professionals, is best served in person. And the virtual telehealth platforms, especially if they are audio-only, can make it harder to diagnose some symptoms or conditions. Others also point to the importance of the doctor-patient relationship and say that encouraging the online engagements over the in-person visits could erode those relationships over time. Removing the face from the patient can lead to further fractures in the patient-provider relationship that many already site as a troublesome power imbalance.

There are also some administrative and cost-related caveats to consider regarding telehealth services. From the standpoint of insurers, the definitive lines of care can be blurry. Is a phone call or audio-only conversation worth the full price of an in-person exam and discussion? For some providers, those distinctions can translate to a difference of thousands of dollars over time. While the technology exists and continues to develop at the provider and insurer levels, authorization and guidelines will likely determine the official terms and continued adoption of these telehealth channels moving forward, especially if audio-only telehealth becomes more accessible.

Most agree that pending the expansion of audio-only healthcare coverage past the end of the PHE, the CMS would need to develop guidelines as this technology can be used safely by providers and consumers. For continued coverage of how major trends in the health insurance world will impact consumers, look to W3LL!


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