As shutdown persists, pain grows for hospital-at-home, telehealth programs

With Congress making no progress in ending the partial government shutdown, health systems and providers offering telehealth and hospital-at-home programs grow angrier each day.

Millions of Americans use Medicare to access telehealth programs, and Medicare also offered waivers for health systems to provide acute care at home. Those waivers expired when the short-term federal spending bill lapsed at the end of September.

Lawmakers in Congress have expressed broad support for telehealth and hospital-at-home programs, and they are casualties in the bigger spending clash. Kyle Zebley, senior vice president of the American Telemedicine Association, says the frustration is mounting for health systems and other providers.

“It's been a devastating, really harmful setback for these programs,” Zebley told Chief Healthcare Executive®. “It's really unfortunate. It's made worse every day that they remain lapsed.”

“What's really tragic about it is the fact that all of these telehealth flexibilities in the acute hospital care-at-home program are popular, were put in place on a bipartisan basis and kept there on a bipartisan basis,” said Zebley, the executive director of ATA Action, the telemedicine group’s policy arm. “And yet here we are a victim of circumstance, a victim of the dynamics around the current shutdown. So it's worse every day that goes by.”

The telemedicine association is now urging Congress to come up with, at minimum, a short-term remedy to end the disruptions to providers.

(See part of our conversation in this video. The story continues below.)

‘It was avoidable’

While the shutdown isn’t centered on telehealth in any way, virtual care programs and hospital-at-home programs have been impacted.

Democrats in Washington have been seeking extensions of Affordable Care Act tax credits. President Trump and Republicans, who control both the House and Senate have told Democrats they want agreement on a short-term spending bill, and want to address the Affordable Care Act tax credits separately.

With no movement in Congress, disruptions continue for telehealth programs and hospital-at-home programs.

Hundreds of hospitals providing acute care at home have been directed by the Centers for Medicare & Medicaid Services to return their patients to the hospital or discharge those patients. Some health systems have taken those steps, while Mass General Brigham told Politico it has been able to keep its patients at home by using services not covered by the waiver.

Nationwide, 147 health systems, and a total of 419 hospitals, are approved to provide acute care at home, and those programs are operating in 39 states, according to federal data.

Rick Pollack, president and CEO of the American Hospital Association, talked about the need to secure extensions for hospital-at-home and telehealth programs during an appearance at Sanford Health’s summit on rural health care this week.

“Those are things that are bipartisan, but they actually expired,” Pollack said. “And we need to get that re-extended.”

Millions of people use Medicare to pay for telehealth programs, but now they won't have telehealth visits reimbursed.

Zebley said there’s been no indication of a loss of support for telehealth programs in Congress. Republicans and Democrats have shown strong support for telehealth waivers in the past, and President Trump signed off on telehealth extensions in those short-term spending bills. Trump also approved measures easing restrictions on telehealth early in the COVID-19 pandemic.

“We just unfortunately have been wrapped up into this same timeline that has led us to the shutdown for government spending,” Zebley said. “It's meant a lapse in our programs, and it's very unfortunate. We think it was avoidable. It's a great example as to why we need permanency for these items, and if not permanency, at the very least, much longer extensions than these small kick-the-can maneuvers that we've been living under.”

Sara Collins, assistant vice president of professional medical affairs and telehealth for Lifepoint Health, said the expiration of the waivers has affected patients and providers.

“Lifepoint hospitals and clinics operate in rural and underserved regions which depend on telehealth to connect patients with specialists, behavioral health providers, and hospital-level care that would otherwise be out of reach,” Collins said in a statement.

Fears of an extended lapse

While Medicare beneficiaries may see issues with reimbursement for telehealth programs, commercial insurance companies can continue to provide coverage. Zebley said he hasn’t heard of commercial payers balking at covering telehealth services.

But he said that he’s concerned about the ramifications if the shutdown drags on for an extended period.

“We haven't heard of any notable example of those insurance payers that have followed what has occurred in the Medicare Fee-for-Service Program, which is what we're talking about,” Zebley said. “That being said, Medicare is tremendously influential in determining what other payers will cover and the degree to which they'll cover. And so we are very deeply concerned that an extended lapse could negatively impact telehealth coverage in these other programs.”

“There's so much misinformation and apprehension out there in the healthcare ecosystem that it's having a really negative effect as to what is allowed and what isn't, not only amongst patients and beneficiaries, but also health systems and Medicare providers themselves,” he added.

​​Providers have been settling for short-term extensions of telehealth programs since the end of last year. Congress and then-President Biden approved a two-year extension of telehealth programs that expired at the end of 2024. Efforts to secure longer-term extensions have been unsuccessful, as lawmakers agreed on short-term extensions tied to temporary spending bills, first in December 2024 and then again in March.

Seeking certainty

Health systems and telehealth providers have been pushing for permanent reforms, or at least multi-year extensions of telehealth waivers, to provide more certainty for patients and providers.

The American Hospital Association and others have said that some health systems have been reluctant to launch hospital-at-home programs, because of the uncertainty of long-term federal approval of such programs.

Zebley said the lack of permanent reforms for Medicare-backed telehealth programs have deterred providers from launching more virtual care programs, and patients from getting access to them.

“It's just common sense,” Zebley said. “Large healthcare systems, small ones, large hospitals, rural and local hospitals, alongside Medicare providers and their practices and provider groups, they want to make wise choices with the limited dollars they have. And you want to make those investments in areas that you know will be around for a while.”

Eventually, Congress will come together on a short-term spending bill, and it will include an extension for telehealth and hospital-at-home programs, but it will likely be tied to the duration of the spending bill, Zebley said.

So even if the shutdown is resolved quickly, most likely, health systems and other providers will be anxious about another interruption to telehealth programs.

“Anything's better than where we are,” Zebley said.

But he added, “We probably will be back in that circumstance, at the very least for this next measure that will reopen the federal government. … It will happen. And so what again, makes it all the more frustrating is the fact that we've got to go through the pain in order to get through the conclusion that we all knew was inevitable.”