Deal to avert shutdown could prevent disruption to telehealth programs

The last thing health systems want is another interruption of telehealth programs, and it looks like that dire scenario may not happen.

Congressional Democrats reached a deal with the White House to avert a government shutdown, the Associated Press and other media outlets reported late Thursday.

After the fatal shooting of a nurse in Minneapolis, Democrats wanted to separate funding for the Department of Homeland Security from other spending legislation, The Washington Post reports. President Trump’s administration and Democrats agreed to separate the homeland security funding from the bigger spending bill.

Telehealth and hospital-at-home programs have been facing the prospect of being disrupted for the second time in a few months. Telehealth flexibilities are tied to a short-term federal spending bill slated to expire at midnight Friday.

Virtual care and home hospital programs were interrupted during the shutdown last fall. The potential deal should, hopefully, avoid a repeat of that scenario.

Alexis Apple, vice president of public affairs at the American Telemedicine Association, tells Chief Healthcare Executive® that its members have been dreading the prospect of another possible shutdown.

“Two lapses in the past six months is just crazy to me, and it really impacts the patients across the country,” Apple says.

The last shutdown in the fall lasted more than six weeks, becoming the longest in the history of the federal government.

Another shutdown would pose headaches for hospitals and health systems offering telehealth and hospital-at-home programs.

Congress hasn’t signed off on a long-term extension for virtual care programs, leaving them tied to short-term government spending measures for more than a year. Hospitals and health systems have been seeking permanent telehealth reforms, or at least multi-year extensions for virtual and home hospital programs.

The shutdown last fall is more than a bitter memory for some providers, Apple says.

“Our members are still feeling the impact of the last shutdown,” Apple says. “Some members haven't even restarted or started telehealth services since the last shutdown.”

Reasons for optimism

There are reasons for optimism about more substantial extensions for telehealth and hospital-at-home programs.

The House of Representatives has already passed legislation that would authorize a two-year extension of telehealth programs, running through the end of 2027. The House measure also includes a five-year extension for hospital-at-home programs, which would last until the end of 2030. Health systems have been hoping for a longer extension for home hospital programs.

“If these actually get through, and we end up having these multi-year extensions, we can actually work on a road to permanency,” Apple says.

A five-year extension could spur some health systems who have been reluctant to launch home hospital programs to move ahead. The American Hospital Association and others have said that some health systems have been leery of launching hospital-at-home programs, because of the uncertainty of long-term federal approval of such programs.

Nationwide, nearly 400 health systems are offering hospital-at-home programs in 37 states, according to data from the Centers for Medicare & Medicaid Services.

Recent studies have shown low mortality in hospital-at-home programs, and one recent study found strong performance of home hospital programs in rural areas.

Apple says there’s more data backing hospital-at-home programs, which can build a strong case for lasting reforms.

“I think we could see permanence at the end of this, which, to me, is very promising,” she says.

Apple says there could be a brief shutdown, since the Senate is moving to passing separate spending measures. The revised package would likely need to go through the House again.

What could happen

Health systems have been anxious about the potential for a shutdown, and the uncertainty that comes with it.

“Many of our members are just concerned,” Apple says. “I get so many questions every day.”

The telemedicine group and other healthcare organizations have been pressing Congress for reforms, and to separate telehealth programs from short-term spending bills.

“I keep reiterating this to Congress, we need to separate the Medicare tele-flexibilities from government funding moving forward,” Apple says. “They should never be combined, because this is what happens. These are the circumstances that occur, and then unintended consequences happen, which is that millions of Medicare reductions lose access to care overnight.”

Republicans and Democrats continue to be strong supporters of telehealth programs, she says. The last shutdown had nothing to do with divides on virtual care programs.

“Everyone wants to see telehealth continue,” Apple says. “It's just unfortunately, we've been derailed by so many other forces out there.”