The vital need to expand telemedicine waivers in the pandemic era

Jiang Li, Ph.D., is its founder and CEO Vivalink, Inc.

The pandemic catalyzed a shift in healthcare delivery, rapidly expanding telemedicine services to ensure patients could access needed care safely. While the pandemic has faded and public emergency declarations have ended, telemedicine waivers have survived and become urgent to preserve.

To meet the needs of patients and providers during pandemic restrictions, Congress passed legislation allowing Medicare to cover telehealth services. The Centers for Medicare and Medicaid Services (CMS) has taken steps to improve access issuing waivers that loosened restrictions and expanded coverage criteria for telehealth and remote patient monitoring (RPM) services while increasing reimbursement rates for virtual visits.

Embracing remote care at the start of the pandemic was critical for providers to remain operational. Economically, telemedicine has reduced overhead costs and increased efficiency by minimizing unnecessary hospital visits. While telehealth waiver flexibilities enacted during the pandemic have been extended through the end of 2024, continued support for RPM technology remains key to making these home care options a reality.

Lawmakers are exploring further expansions of pandemic-era exemptions and considering legislation to expand home care programs. Advocating for continued access to telemedicine, RPM, and home care services is essential to ensure patients benefit from a variety of care models that provide much-needed health care.

Significance of resignations in the time of the pandemic

Telehealth has greatly expanded access to essential medical services in various demographics. ONE US Census Bureau survey revealed that the highest rates of telehealth visits were among those covered by Medicaid and Medicare between 2021 and 2022. Telehealth use was also particularly high among black patients and those earning less than $25,000 per year. Although telehealth use was lower during the survey period compared to earlier in the pandemic, it remained above pre-pandemic levels.

While telemedicine, a subset of telehealth, encompasses a range of remote healthcare services, including virtual consultations and visits, RPM involves the use of technologies such as wearable sensors for remote monitoring and management. Telemedicine has played an important role in supporting home care. However, continued advances in RPM technology will likely be the driving force behind continued adoption and implementation of hospital home care settings.

As pandemic-era waivers come to an end, policymakers are increasingly recognizing the value of telemedicine and RPMs. In May 2024, the US House of Representatives Committee on Ways and Means green light law extend pandemic-era flexibilities by allowing Medicare patients to continue to access telehealth services for an additional two years. The measure shows that policymakers recognize the benefits of telemedicine and RPMs in modern healthcare and will give healthcare systems time to implement key virtual technologies.

Effects of Hospital Home Care

Policy makers are also focusing on five-year extension of CMS’s Acute Hospital Care at Home (AHCAH) waiver program, which allows enrolled hospitals to be reimbursed for providing acute hospital care in patients’ homes.

The implementation of the program has significantly expanded access to care, particularly for patients requiring acute medical care. As of June 2024, 331 hospitals in 37 states have been approved to provide care under the program, facilitating the broad expansion of home care options.

To understand consumer perspectives on home patient monitoring experiences, we over 1,000 patients were surveyed. The results revealed a strong interest and positive perception of home hospital care. Almost half of the patients surveyed had participated in hospice at home (HaH) programs and of these, 84% reported a positive experience with the program.

Especially, 77% stated that they would trust their healthcare provider’s recommendation to use home monitoring to monitor vital signs after hospital discharge. The results indicate growing trust and acceptance of remote health care solutions, further supporting the importance of expanding and expanding access to hospital home care programs.

Challenges without waivers

Without the flexibility provided by the pandemic-era exemptions, patients (especially those in rural communities) could lose access to essential health care services. RPM has been instrumental in overcoming geographic barriers and expanding care to populations with limited resources or transportation options.

Research on the CMS AHCAH waiver revealed that patients who received home care through the program experienced favorable outcomes, including low mortality rates and minimal complications. Delivering acute care outside of traditional hospital settings has proven effective, with RPM technology continuing to drive the adoption of home hospital care.

While RPM is not without challenges, such as access to technology, infrastructure, and provider adoption, continued reimbursement presents an opportunity to address these barriers and advance RPM implementation, ensuring equitable and efficient delivery of care.

By securing the reimbursement structure, policymakers can establish the role of telemedicine and RPMs in health care beyond the immediate challenges of the pandemic. Support for the continuation of these exemptions ensures that telemedicine technology remains an integral part of health care delivery, enabling a patient-centered system that effectively responds to the diverse needs of individuals and communities.

Emphasizing Innovation Despite Uncertainty

Significant strides have been made to advance telehealth technology and home-based programs worldwide. While the potential expiration of the waivers creates uncertainty, the success and adoption of these technologies, particularly among leading hospitals, underscores the need to maintain investment in their development. If for no other reason than to remain competitive and serve the evolving needs of patients, hospitals must continue to innovate in patient care.

Ensuring hospitals have access to essential technologies and promoting technology that enables home hospital care should be priorities, even if the exemptions expire. These programs have already been shown to be effective in improving access to care, reducing costs and improving patient outcomes.

It is important that this progress continues. By focusing on simple, accessible solutions for hospitals and user-friendly RPM technology, we can ensure that these advances continue to benefit patients.

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