GAO to Senate on telehealth expansion: Not so fast
Telehealth was essential during the pandemic, but officials say there's not enough evidence to show it's as effective as in-person visits.
The jury is still out on the expansion of telehealth coverage for Medicare and Medicaid programs, according to testimony before the U.S. Senate this week from the General Accounting Office.
Although telehealth services were important early in the pandemic, GAO officials said there have not been enough studies to show that they are as effective as in-person visits. They also noted potentially higher costs and an increased risk of fraud, waste and abuse.
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In response to the pandemic, the Centers for Medicare & Medicaid Service made widespread use of program waivers and other flexibilities to expand beneficiary access to care.
“The long-term effect of these waivers on spending and quality of care is not yet known,” a GAO official said. “In addition, we reported that careful monitoring and oversight is warranted to prevent potential fraud, waste and abuse that can arise from these new waivers.”
Preliminary information on the effects of these waivers led to several observations.
Utilization. During the first eight months of the pandemic, use of telehealth services in Medicare fee for service sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late April. Utilization then dropped to about 1.3 million services by the beginning of June and generally continued to slowly drop through mid-October.
Access to care. CMS approved more than 600 waivers or other flexibilities aimed at addressing obstacles to beneficiary care, provider availability and program enrollment. The GAO has reported certain flexibilities such as telehealth as critical in reducing obstacles to care. Spending. Telehealth waivers can increase spending in both programs if telehealth services are furnished in addition to in-person services. However, the long-term effect of these waivers on spending and quality of care is not yet known.
Program integrity. The suspension of some program safeguards has increased the risks of fraud, waste and abuse that GAO previously noted.
Beneficiary health and safety. Although telehealth has enabled the safe provision of services, the quality of telehealth services has not been fully analyzed.
Equity. The testimony also asserted that to ensure that all beneficiaries receive the best care possible, waivers for Medicaid and Medicare should account for equity.
“Continuing these flexibilities after the public health emergency declarations end could increase certain risks to the Medicare and Medicaid programs,” a GAO official concluded. “Careful consideration of these benefits and risks will be key to determining the path forward, especially given that both programs are on GAO’s high-risk list.”
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