The Future of Telemedicine: Benefits for Patients and Doctors

The AMA Update presents a variety of healthcare subjects that influence the lives of physicians, residents, medical students, and patients. Experts in the field speak on COVID-19, medical education, advocacy issues, burnout, vaccines, and much more-from private practice or health system leaders to scientists and public health officials.

Featured topic and speakers.

What is the future of telemedicine? What are the threats to telehealth? Do doctors like telemedicine? What telehealth services does Medicare cover?

Our guest is Dana Lichtenberg, Assistant Director for Congressional Affairs, American Medical Association. Hosted by AMA Chief Experience Officer Todd Unger.

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Speaker:

Dana Lichtenberg, Assistant Director, Congressional Affairs, AMA

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Transcription

Unger: Well, hello and welcome to the episode of the AMA Update video and podcast. Today, we’re discussing work happening on a federal level to fight for the future of telehealth access. We have with us Dana Lichtenberg, assistant director for Congressional Affairs for the AMA out of Washington, DC. And I’m Todd Unger, AMA’s chief experience officer from Chicago. Dana, welcome.

Lichtenberg: Thanks, Todd. Great to be here.

Unger: Well, as we all know, telehealth was in the fast lane during the pandemic. And of course, that happened with the passage of federal legislation that occurred in March of 2020. I personally don’t like recalling anything about March 2020. It consequently demands little memory. But we are going to start there with a little bit of a background from you about what exactly that legislation was and what it did.

Lichtenberg: Well, we can start with kind of the official jargon. Under a very old Medicare law, telehealth services can only go to a rural patient, and you have to go into a health care facility in order to receive them, which makes absolutely no sense. The law predates the internet. It predates cell phones. It is basically a remnant from the past.

When COVID hit, as part of the COVID relief bill, Congress lifted restrictions in such a way that now all Medicare beneficiaries have access to telehealth services that are covered and paid for by Medicare. Congress took another step in 2022 and extended those flexibilities for two years. And so we are here today.

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Unger: It’s hard to think that some of those things were kind of set back before thinking about remote work and Teams and Zoom and all of that, the assumptions that were built into that. So the AMA has been working to make those telehealth flexibilities permanent. What progress has been made?

Lichtenberg: Very successful. Telehealth is so very popular. It has become part and parcel of medicine. Most members of Congress have had a telehealth visit in the last five years. It is all patients and most of the physicians who are using it.

They may work directly with Congress to help them draft legislation that becomes the basis of both waiver extensions. We wanted to make sure that they did exactly what they needed to do, and they didn’t have any extra things that they didn’t need to do—for example, putting in-person requirements on tele-mental health services or reporting requirements that were unnecessary.

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Unger: That’s fabulous. And even quite late in the day in May, a bill that would extend the expiring telehealth flexibility for another couple of years passed the committee with unanimous votes. What other major milestones could we be looking at?

Lichtenberg: Yes. After that, the Energy and Commerce Health Subcommittee passed a virtually identical bill, but it included a couple of additional items. For example, it authorized Medicare to do an observation for a virtual diabetes prevention program. So we are very excited about the direction of those two bills. We expect the Finance Committee on the Senate side will act on similar legislation in September.

Unger: Please remind us all why it is so important for telehealth flexibilities to, in fact, be put in place permanently?

Lichtenberg: If Congress does not act before the end of this year, Medicare will pay for telehealth services only if you are living in a rural area. Nobody wants to see that happen. This is why telehealth has become a part of practice. It is what the patients expect, it is what the doctors want to do, and so it has had an overarching good impact on the health care system.

Unger: Well, thank God, there is legislation on the table that would provide a long-term solution. What about that, and where does it stand now?

Lichtenberg: Unfortunately, the real reason to date has been the higher cost. So, the projections from the Congressional Budget Office, concerning the 2-year extension, suggest a $2 billion/year price tag because of increased utilization of Medicare services. So, cost has been the primary reason for the lack of action until now.

Will Congress do nothing to save telehealth? We expect absolutely nothing of that in our books. At the year’s end, Congress will enact a two-year extension of the telehealth authorities offered. The issue here is, progressing forward, would we be able to get the data with the help of telehealth, illustrating its good effects on the health care system and patients’ outcomes to the Congressional Budget Office?

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We know from our own research very clearly that costs can be saved. Telehealth can help cut down on ER visits, for example. And this is something we have seen in our own research, it is true towards research done by other players in the health care community. We know it does better in helping patients get better outcomes. For instance, it can greatly help in delivering services that support patients in managing their A1C or blood pressure. Those are measurable outcomes. So the strategy is to work together with the coalition we formed in DC and in Congress to pull the data together to submit to the Congressional Budget Office for the purposes of reducing their score so that we can do commonsensical things and really make it permanent. There is no basis for having any restrictions in the first place.

Unger: And that makes sense, and that’s something that the advocacy team is very good at, getting that data and, of course, presenting that with Congress and that whole lot of affiliated parties there. For the practicing physician, health system out there, when they’re thinking about investing in their telehealth, what do you do in the meantime with all this uncertainty?

Lichtenberg: “I’m 99.9% certain that Congress will offer a two-year extension, and I’m also 99.9% certain that we will eventually reach some kind of permanent solution to the problem. I think the problem is, this may be an extender for a while, meaning every two years Congress acts to extend it again. Over time, it’s going to become pretty costly. Telehealth is part of the Medicare package now. Medicare continues to increase the services through which care can be provided virtually. So at some point, there will be a tipping point. We’ll have enough data to show that, yes indeed, this doesn’t increase costs. And then we go from there. But for right now, I very much feel that Congress will act. We have heard absolutely nothing in DC that would indicate otherwise.”

Unger: Well, that’s definitely good news. Dana, I just want to acknowledge you and the advocacy team for all the hard work that got all of this rolling in the first place. Certainly, telehealth has just become such an important mechanism in health care now for both physicians and patients. So thank you for being with us today-and giving us this very necessary update.

And for all those out there who think advocacy for telehealth really matters, we will encourage you to join as an AMA member at ama-assn.org/join. This will do it for today’s episode, and we will be back soon with an update. Be sure to subscribe to new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

Conclusion:

Telemedicine is the future of healthcare, now being defined by accessibility, affordability, and patient-centricity. And with this very concept, convenience, cost savings, and timely care come for the patients, while its advantages for doctors would include efficiency, greater reach, and advanced diagnostic tools. Technologies such as AI, wearables, and remote monitoring are expected to turn telemedicine from reactive “treatments” to preventive, personalized healthcare solutions. The sector still grapples with challenges such as digital access and data security; however, with time and support policy, the system gets stronger. Telemedicine is not only the future of healthcare; it is actually the pathway of the present toward an intelligent and healthy tomorrow.

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