MedPAC cautious on permanent telehealth expansion

March 15, 2021


Despite enthusiasm for telehealth among consumers, politicians and many in the healthcare industry, the Medicare Payment Advisory Commission doesn’t want fee-for-service Medicare to go all-in on telehealth until federal policymakers have more evidence about how it affects the program, according to a MedPAC report on Monday.

The congressional advisory panel recommended that policymakers continue some expanded telehealth services for one to two years after the public health emergency ends to allow policymakers to collect and analyze more information about telehealth’s effects on Medicare access, quality, cost and fraud.

The commission is especially concerned about telehealth’s impact on the integrity of the Medicare program because the technology could allow providers to “commit fraud at scale,” James Mathews, executive director of MedPAC’s staff, said during a call with reporters.

MedPAC suggested that the Medicare program continue to temporarily pay providers for specific telehealth services delivered to all beneficiaries, regardless of their location. It also recommended that Medicare cover some additional telehealth services if they could potentially offer clinical benefits, including audio-only services.

MedPAC said that Medicare should return to paying the physician fee schedule’s facility rate for telehealth services and collect data on the cost of providing such services after the public health emergency ends.

To combat unnecessary spending and possible fraud, MedPAC said that providers shouldn’t be allowed to reduce or waive beneficiaries’ cost sharing for telehealth services once the public health emergency ends. It also wants federal regulators to further examine clinicians that bill for significantly more telehealth services than other providers and require in-person visits to order high-cost durable medical equipment or lab tests. MedPAC said federal policymakers should ban physicians from billing for telehealth services delivered by nonphysician staff if those staff can bill Medicare directly.

CMS temporarily expanded telehealth reimbursement during the public health emergency to ensure that fee-for-service Medicare beneficiaries would have some access to healthcare services during the COVID-19 pandemic. Now there’s growing momentum to make the changes permanent, even though there’s relatively little evidence about telehealth’s impact on the Medicare program and its beneficiaries.