Chairman Doggett Opening Statement at Health Subcommittee Hearing on Charting the Path Forward for Telehealth
(As prepared for delivery)
“Telehealth”: a term that has become so prominent in health care during our ongoing pandemic. Today, we are “charting the path forward on telehealth.” Unlike terms to which many of us have become bound almost daily, but are also eager to retire, are “Let’s Zoom,” “six feet apart,” and the reoccurring guidance: “please unmute yourself.” Unlike these, telehealth is a concept that is sure to stay. Yet we need to fully explore how it stays – and at what cost in dollars and quality of health care – to preserve patient choice, protect beneficiaries from fraud and exploitation, and avoid exacerbating longstanding health disparities.
Far more than just a pandemic buzzword, telehealth has allowed essential health care workers to provide primary care, specialty care, patient monitoring, case management—all while reducing the spread of COVID-19. This expansion has demonstrated that telemedicine can be integrated into health care plans and used by professionals with preestablished patient relationships, who can best assess a patient’s needs. Pre-dating the pandemic, telehealth’s promise has long been available, but the past year has charted a path forward for better quality and more comprehensive use.
For Medicare, this transformation was made possible thanks to waivers granted by CMS to cover 144 telehealth services during the Public Health Emergency. This flexibility allowed for a rapid and prolific expansion of services for 24 million Medicare beneficiaries last year from Mid-March to mid-October, alone.
Depending upon how implemented, telehealth can either worsen or ameliorate health inequities. Barriers like transportation or affordable child care are removed. It has the potential to improve the patient experience by expanding language access and providing culturally competent care. It has also allowed family members to facilitate telehealth appointments to serve as advocates for vulnerable loved ones. But the availability and cost of technology and broadband are crucial to make telehealth a successful care delivery model for the many economically disadvantaged beneficiaries, people of color, people with disabilities, people who are not tech adept. While audio-only visits can increase access, we must avoid a two-tiered system where affluent patients receive video and in-person visits as low-income beneficiaries receive only a phone call. In his American Jobs Plan, President Biden has outlined an ambitious $100 billion expansion of broadband infrastructure—a provision that appears to have garnered some bipartisan support.
With CMS telehealth waivers currently extended through yearend, we need a plan in place to assure no abrupt suspension. Though recognizing the great promise of telehealth, the Medicare Payment Advisory Commission (MedPAC) last month noted that our understanding of the impact of telehealth is largely limited to data and experience covering only a few months. It recommended that Congress initially provide a limited extension to permit a little additional time for gathering evidence about the impact of telehealth on access, quality, and cost. While pay parity between telemedicine and in-person care has spurred rapid adoption, we must evaluate that impact on Medicare spending and ensure a telemedicine appointment is not duplicating an in-person visit.
A number of our colleagues have introduced telehealth-related legislation. I particularly salute Mr. Thompson and Mr. Schweikert for their proposals and their longstanding telehealth advocacy. While not a markup, I hope this hearing will enable us to move forward toward a full committee markup on several bills. To implement the MedPAC recommendation, I will be introducing a bill of my own to extend existing telehealth waivers following the conclusion of the Public Health Emergency. This will permit MedPAC and HHS to evaluate the impact on health care delivery, Medicare spending and utilization as well as to assess the quality of care delivered in order to provide evidence-based recommendations to Congress regarding likely permanent changes to Medicare.
With Medicare representing the primary subject jurisdiction of this Health Subcommittee, we are the stewards of Medicare with a special responsibility to protect both vulnerable beneficiaries and taxpayers from telehealth fraud schemes—schemes which pre-dated the pandemic and are not all that dissimilar from fraud that has impacted traditional health care delivery. The Department of Justice has reported that 50 physicians were responsible for $1.2 billion in taxpayer losses after ordering unnecessary back, shoulder, and knee braces. In another scheme, Medicare was fraudulently billed $2.1 billion for cancer genetic tests.
I believe we can mitigate these scams by requiring an in-person appointment prior to ordering high-cost durable medical equipment or major clinical laboratory tests. The anti-fraud provisions of my legislation would also authorize CMS to audit outlier physicians ordering DME and lab tests at high rates and recover fraudulent payments, as well as to ensure that CMS tracks who is billing for DME and lab tests by requiring that any clinician who is able to bill Medicare directly must do so under their own national provider identifier (NPI) when they deliver a telehealth service to a beneficiary.
I look forward to hearing from our strong panel of witnesses from whom we have intentionally sought diverse views for this bipartisan hearing. We look forward to your expert counsel in offering a blueprint for how to best chart a path forward on telehealth by building a system that promotes equity, expands access, and upholds program integrity to ensure patients receive virtual care with tangible results.