Roosevelt Institute | Cornell University

Telehealth Policy Changes: Ad Hoc Solutions to a Pandemic or Sustained Improvement to Access, Cost, and Quality of Care?

By Alicia DuranPublished August 29, 2021

The COVID-19 pandemic spurred sharp uptake of telehealth services by patients and providers. Prior to the public health emergency, telehealth in the United States worked inefficiently for Medicare beneficiaries; ad hoc changes to telehealth policies during the pandemic improved access, cost, and quality of care for the public and private insurance market. However, the sustainability of the these improvements is at risk as decisions to revert changes to telehealth policy are made.

Prior to the COVID-19 pandemic, telehealth services in the United States were working inefficiently for a select group of beneficiaries. Patients eligible to receive telehealth services included only Medicare beneficiaries who resided in a remote or rural area. Furthermore, to receive telehealth services, patients had to travel to the originating site of care, such as hospitals or clinics. Lastly, only real-time audio and video services were eligible for reimbursement. Altogether, pre-pandemic telehealth policies limited the impact of telehealth services. However, ad hoc changes to telehealth policies, influencing similar changes in the private insurance market, sharply increased the impact of telehealth in the United States: more telehealth visits were made during the first three months of 2020 than during the same time period in 2019. Thus, changes to telehealth policy should be made permanent after the public health emergency has subsided to sustain improved access, cost, and quality of care across the United States.

Changes to telehealth policy have increased access to care for patients across the United States. One change suspended restrictions on telehealth-eligible areas: previously, 7.8 million patients were eligible to receive services; after the change, all 36 million Medicare beneficiaries had access to telehealth services. Likewise, another change waived restrictions on originating site rules—where the patient is physically located at the time of care. Pre-pandemic policies required the patient to travel to a hospital or clinic to receive telehealth services. Now, patients are able to receive services from home, reducing the transportation barriers to care that affect 15% of Medicare beneficiaries. Finally, policy changes expanded the list of services eligible for telehealth delivery. Prior to the change, few specialists provided care via telehealth; after the policy change, endocrinologists, gastroenterologists, neurologists, and pain management physicians were among the specialists who used telehealth most frequently, increasing access to specialty care via telehealth services. Altogether, changes to telehealth policy during the public health emergency reduced barriers to care, and these changes should be made permanent to sustain improved access to care.

Changes to telehealth policy decreased cost of care for patients and providers. Previously, technology used for telehealth services was required to be HIPAA compliant but, during the crisis, HIPAA requirements were waived. This change eliminated the high-up front investment in hardware and software for physicians, allowing patients and providers to use a variety of apps and technologies for telehealth such as FaceTime, WhatsApp, and Facebook Messenger. Although privacy risks are a concern, physicians were encouraged to enable all encryption and privacy modes available on video chat applications, resulting in more secure and accessible modes of care. Likewise, audio-only delivery became an allowable telehealth service during the public health crisis, allowing patients without broadband internet to access telehealth services. Furthermore, pre-pandemic policies required patients to pay a deductible or coinsurance for telehealth services; however, changes allowed providers to reduce or waive this fee under Medicare, reducing the cost of care for Medicare patients receiving telehealth services. Altogether, changes made to telehealth policy during the pandemic decreased costs for patients and providers. These changes should also be made permanent to sustain cost savings to care.

Opponents of telehealth argue that an in-person visit is always better than a virtual visit, but telehealth visits may offer the same or better quality of care compared to some in-person visits. Of the people who used telehealth services during the pandemic, 80% reported patient satisfaction. Another 78% reported feeling their health concern could be addressed via telehealth. Notably, one study found patient satisfaction to be significantly higher among telehealth visits compared to in-person visits, both before and during the public health emergency. As changes to telehealth policy have increased access to telehealth services, they have also increased access to quality care. Thus, changes to telehealth policy during the COVID-19 pandemic should be made permanent to sustain access to quality care.

The COVID-19 pandemic spurred sharp uptake of telehealth services by patients and providers, increasing usage by 157% by the end of March 2020. Changing telehealth policies have been critical for maintaining access to care during the crisis, as well as for improving access, cost, and quality of care after the pandemic. It is unlikely that telehealth usage will decrease to pre-pandemic levels: 70% of patients who received telehealth services during the pandemic expect to access telehealth services after the end of the crisis. Thus, changes to telehealth policies governing care delivery and reimbursement for Medicare beneficiaries will need to be preserved post-pandemic, in order to ensure sustained improvement to access, cost, and quality of care for patients.