Evidence of quality telehealth care could push Congress to extend pandemic-era waivers

Article by Rajiv Leventhal | Oct 6, 2022

The news: Using telehealth to augment office-based primary care generates patient outcomes that are on par or better than in-person visits only, according to a study recently published in JAMA Network Open.

How the study worked: More than half a million (526,874) patients of all ages were divided into two groups: those who received only in-person care (77.8%) and individuals who used telehealth on its own or in combination with office visits (22.2%).

Patients were treated between March 2020 and November 2021 in five areas: cardiovascular care, diabetes, prevention and wellness, behavioral health, and respiratory care. Researchers assessed outcomes via the Healthcare Effectiveness Data and Information Set (HEDIS), a quality measurement tool used by more than 90% of US payers to measure care performance.

Digging into the data: Some findings from the study that grabbed our attention:

1. Patients who had some telehealth exposure outperformed those who didn’t—with statistically significant differences—in 11 of the 16 quality measures studied. For example, patients who had virtual visits were more likely to maintain their blood pressure, keep up with preventive diabetes testing and diabetes management testing, and get screened for breast and cervical cancer.

2. Consumers in the office-only care group did slightly outperform those in the telehealth-exposed cohort in medication-based measures. That includes those with cardiovascular disease receiving antiplatelets and diabetic patients getting statins. However, the researchers noted some study limitations—principally that they couldn’t control the number of visits between the two groups since in-person care is far more prevalent.

The bigger picture: We’re not surprised that increased access to care via convenient virtual interactions helps patients stay on track with preventative care and disease management. But we are hopeful that studies like this will help satisfy the powers that be that for certain conditions, telehealth can deliver the same quality of care, or better, than office-based visits.

Longstanding barriers to delivering telehealth were mostly removed in response to the public health emergency (PHE). For example, Medicare expanded the number of services they'd reimburse clinicians for, and state-level restrictions around provider licensing were dropped. But those regulations might go back into place once the PHE expires, which could be as soon as January 2023.

Telehealth’s fate lies at the steps of Capitol Hill: Many of the pandemic-era telehealth waivers can only become permanent through congressional vote. And the Government Accountability Office (GAO), a congressional watchdog, still wants to be assured that the quality of care doesn’t suffer during virtual visits.

A September report from GAO questioned if the quality of telehealth services is equivalent to in-person ones, recommending that the Centers for Medicare & Medicaid Services (CMS) comprehensively assess the value of virtual care.

Legislation is moving forward, though. Earlier this year, the House voted to extend pandemic telehealth flexibilities under Medicare (commercial insurers usually follow the government’s lead) through at least 2024. Now, the bill moves to the Senate.