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Telehealth is facing a pivot point in 2024. Federal and state agencies are evolving their regulations, while payors and health systems are reevaluating the best use cases for virtual care. Fortunately, most policies supporting telehealth implemented during the pandemic are still in place. However, several federal telehealth policies are set to expire at the end of 2024. Regardless, there is little doubt that virtual care is here to stay, and at much higher levels of telehealth usage than before the pandemic. Here are four telehealth trends to watch in 2024.
1. Some federal waivers and provisions are set to expire in 2024
“At the federal level, the outlook is good but uncertain,” says Kyle Zebley, senior vice president of public policy for the American Telemedicine Association. “For either legislative purposes or regulatory purposes, a lot of things are converging on one date, December 31, 2024, so we’re calling this year the Telehealth Super Bowl because so much lines up and the impact is so huge for our community.”
The issues that will require action this year include:
- Site waivers. Several temporary Medicare changes are set to expire, including geographic and originating site flexibilities for all Medicare beneficiaries as well as site waivers that allow Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) to serve as distant site providers for telehealth services.
- In-person follow-ups for mental telehealth. Another waiver set to expire eliminates the need for a follow-up, in-person visit within six months of an initial telemental health visit.
- HSA safe harbor. Expiring legislation allows high-deductible health plans (HDHPs) to provide first-dollar coverage of telehealth services without impacting plan members’ pre-tax health savings account (HSA) contributions.
- Controlled substance prescribing. The Drug Enforcement Administration (DEA) established temporary guidelines allowing telehealth providers to establish a relationship for prescribing controlled substances without a prior in-person visit.
- Provider privacy. This issue involves Medicare telehealth providers being able to maintain their privacy on the location from which they initiate their patient encounters via telehealth — such as their home address — on Medicare claim forms.
- Acute hospital care at home. This waiver eliminates the need for on-site nursing services to be provided 24 hours a day, seven days a week, paving the way for remote patient monitoring.
“All of those things are lined up for expiration come December 31, 2024,” says Zebley. The ATA is hopeful that these issues will be acted on before the end of the year, especially because these telehealth provisions have widespread, bipartisan support.
2. State action is still needed
State governments have “moved massively” toward making telehealth more accessible, according to Zebley. More than 40 states have permanently updated their telehealth laws after the successful expansion of telehealth during the pandemic.
States have removed many rural restrictions and in other ways have “leveled the playing field” for providers to deliver appropriate telehealth services, Zebley says. Additionally, every state Medicaid program covers telehealth to some degree.
Work still needs to be done to make it easier for telehealth providers to operate across state lines. This is a particularly thorny issue because it requires action in every state legislature. “Many states have implemented licensure compacts, but not all are equal, some better than others,” Zebley says. The ATA is seeing momentum around adopting “common sense exceptions” to licensing requirements, including second options, consultations, follow-up care, and care received while traveling.
“The problem is obviously the complexity of state law. No two states are alike,” Zebley says. Often, state boards can, with the best intentions, create rules that end up “being protectionist in nature — basically keeping licensed medical professionals in good standing from other states out, and that doesn’t allow for the full potential of telehealth.”
Get the toolkit: Telehealth rules and resources
3. Payors are reevaluating telehealth policies
Many commercial payors have taken the end of the Public Health Emergency as a signal to reevaluate their telehealth coverage policies.
“It’s fundamentally improved in terms of commercial insurance coverage and reimbursement for telehealth services as compared to prior to the pandemic,” Zebley explains. “Commercial plans are responding to the desire of their beneficiaries to make sure that these are offered and that’s true across demographic groups, not just among the young.”
Pay parity laws governing telehealth visits are another issue that’s being hammered out on the state level. “About half the states in the country do have mandated pay parity,” says Zebley. “Regardless of pay parity laws, however, every commercial coverage policy that I have found has telehealth coverage to some degree.”
4. Health systems are expanding virtual care
Amid the swirl of federal, state, and payor policies, healthcare organizations are forging ahead with their telehealth programs. Many on-the-ground telehealth trends are related to implementation: What specialties are best suited to virtual care? How will telehealth programs be staffed? How does telehealth play into an organization’s financial models? How will physicians embrace virtual care? What is the role of virtual nurses?
With an ongoing healthcare worker shortage, telehealth may be able to help make best use of available resources. “What telehealth can do is help right-size the supply of our healthcare workers and workforce with demand by better and more efficiently distributing the workforce through virtual care technology,” Zebley says.
Some organizations are looking at telehealth as “workforce triage,” says Matt Brown, vice president of telehealth at CHG Healthcare. He points out that healthcare facilities are asking, “How do we use our own staff versus external virtual staff versus a locum tenens agency versus AI or some other technology? Whether it’s self-service or provider-supported, how can a virtual component support the workflow and alleviate some of the pressure on the system?”
Look ahead: Predictions on the future of virtual care
Investment leads to growth
Telehealth solutions certainly require an upfront investment. However, telehealth can also bring in new revenue while optimizing workforce resources. “If you are not offering the best telehealth services, you will have put yourself at a significant disadvantage because that’s what the providers and the patients want,” Zebley says. “Can you afford not to offer robust telehealth services?”
At the end of the day, telehealth is becoming a basic requirement for delivering care, he says. “If you’re not investing in virtual care options now — if you don’t have a full, robust plan on delivering synchronous audiovisual care, asynchronous care — taking advantage of the whole range of remote monitoring options — when are you going to do so? Your competitors certainly are doing it now, and you don’t want to be left behind,” Zebley says.
To learn how locum tenens providers can elevate your telehealth program, give us a call at 866.588.5996 or email ecs.contact@chghealthcare.com.
