Report: Telehealth flexibility deadline looms, but Congress needs better information to decide

Congress is poised to consider proposals that permanently or temporarily extend flexibilities for telehealth services enacted during the COVID-19 pandemic that are set to expire at the end of 2024. A new joint report by the Paragon Institute and the Competitive Enterprise Institute reviews evidence from before, during, and after the pandemic on how telehealth has been utilized and how it affects healthcare access, cost, and quality. The report urges lawmakers to not permanently extend the flexibilities and, instead, pair any temporary extension with research seeking more information on those three concerns.

Telehealth—the use of remote audio and/or video technologies to provide health care services—has been promoted as a way to provide cost-effective treatments, empower patient self-management, offer greater convenience, and alleviate access problems, particularly in underserved areas like rural communities.

Telehealth usage rose rapidly early in the pandemic but returned to nearly pre-pandemic levels in most fields of medicine. Total telehealth utilization remains above pre-pandemic levels, primarily due to mental and behavioral telehealth services. Overall mental health claims jumped during the pandemic and remain well above pre-pandemic levels due to increased telehealth usage.

So far, though, it’s unclear whether telehealth is proving cost-effective or offering, outside of mental and behavioral health services, the same quality as in-person health care.

“Congress and state and local governments should resolve questions about the quality and cost-effectiveness of telehealth services before greenlighting its permanent expansion in government programs, which could trigger increased and possibly wasteful spending,” said Paragon/CEI health policy expert Joel M. Zinberg, author of the report.

Specifically, Congress should direct CMS or another agency to determine if the increase in telehealth utilization, most popular in mental health services, is meeting previously unmet needs and providing health-enhancing services at a reasonable cost – or whether it amounts to costly overutilization. Private insurers, including Medicare Advantage plans, that bear the risk of overutilization and increased costs would remain free to provide access to telehealth.

Among the report’s findings:

• Despite the expectation that telehealth would be particularly important in rural areas and across state lines, telehealth, with the possible exception of mental health and substance abuse services, was more heavily utilized in urban areas.
• Telehealth appears most useful and accurate in areas of medicine where physical examination is less important or unneeded such as mental and behavioral health. 
• There was troubling evidence of overprescription of antibiotics for inappropriate indications at telehealth visits which could exacerbate the problem of increasing antibiotic resistance.
• Despite claims that telehealth would cut costs, it is likely that increased telehealth availability and utilization increased health care spending.