As shutdown reaches one month, health systems see impact

The federal government shutdown has lasted for a month, and hospitals and health systems have seen disruptions.

Telehealth and hospital-at-home programs have been impacted by the government shutdown, which began Oct. 1. Federal waivers allowing Medicare beneficiaries to use telehealth programs lapsed when the short-term legislation funding all government programs expired last month.

The waivers also affect hospital-at-home programs. The Centers for Medicare & Medicaid Services directed health systems to transfer patients receiving acute care at home back to brick-and-mortar hospitals or to discharge the patients. Nationwide, 147 health systems, and a total of 419 hospitals, are approved to provide acute care at home, according to federal data.

Telehealth programs have enjoyed strong support from Congress and President Trump, and they aren’t contributing to the partisan clashes that have led to the shutdown, says Kyle Zebley, senior vice president of public policy for the American Telemedicine Association.

“We're a victim of circumstance,” Zebley told Chief Healthcare Executive in a recent interview. “We are caught up in dynamics that have nothing to do with us. It's most unfortunate, but we are not the problem. The problem is the breakdown in dialogue over government funding.”

Clash over tax credits

Lawmakers are clashing over a key health care issue that is at the heart of the shutdown. Democratic lawmakers have insisted that any new spending legislation must include an extension of tax credits for the Affordable Care Act. The tax credits help millions of Americans buy coverage, and the credits are slated to expire at the end of the year.

Hospitals have urged Congress to sign off on an extension of the tax credits, saying that millions of Americans could lose coverage without the tax credits. Plus, consumers are looking at higher insurance premiums which could be too expensive without the tax credits, healthcare leaders say.

Speaking at the HLTH conference, Mark Cuban said he expects Congress could see more pressure to end the shutdown - and extend the tax credits - when Americans begin open enrollment and find out they won’t be able to afford health insurance.

“I think when people start going to open enrollment on November 1, it will be enough of a freak out on the actual price, because that's when it hits home,” Cuban said. “You know, people say the price is going up. It doesn't resonate. When they try to register, or realize they're not going to be able to get insurance that they can afford, that's going to be the problem.”

• Read more: Mark Cuban on health care’s failings: ‘We are complicit’

‘Disheartening and disruptive’

For health systems and patients relying on Medicare for telehealth services, the shutdown has posed real problems.

Helen Hughes MD, medical director of Johns Hopkins Medicine’s office of telemedicine, said in a statement, “Seeing the government shutdown stall our telehealth progress has been deeply disheartening and disruptive.”

“As we watch vital access to care slip away, we hope Congress will act swiftly to permanently restore these essential services for our patients,” Hughes said.

Rahul Banerjee, MD, wrote about the disruptions to telehealth services affecting cancer patients in an essay for Blood Cancers Today.

“Multiple myeloma is primarily a cancer of older adults, and a sizable number of patients living with myeloma thus have Medicare insurance,” Banerjee wrote. “The sudden removal of these patients’ ability to see their oncologists via telehealth has created chaos for clinics across the country as we balance Advance Beneficiary Notices, mainly regarding potential non-reimbursement.”

Hospitals and telehealth providers have been pushing for permanent reforms for virtual care and hospital-at-home programs. At minimum, they are pushing for multi-year extensions so providers can have some certainty and patients would see fewer risks of interruptions to care. The American Hospital Association says health systems have postponed offering hospital-at-home programs due to the lack of certainty regarding federal support for the programs.

As it stands, telehealth providers are looking for Congress to pass a short-term spending plan to reopen the government, which will almost certainly include a short-term extension of waivers for telehealth and hospital-at-home programs. But again, the length of those waivers will likely match the length of the larger spending bill.

So when the government reopens, telehealth advocates will be bracing for another disruption, and pushing Congress to offer a permanent remedy, or a long-term solution.

“What I really, sincerely hope and have communicated to our members is that this lapse will be a rallying cry that will prove to policy makers the error of their ways,” Zebley said.

“And again, I say that totally understanding our bipartisan support, being so grateful for it,” he added. “Never will we as a community take that for granted. But despite all that support and despite all that gratitude that we've shown for it, we still have ended up the victim here. So I'm hoping that we can build a case for why we need permanency, and again, if not permanency, at the very least a multi-year extension of these flexibilities.”

The Supplemental Nutrition Assistance Program, also known as SNAP, runs out of money on Nov. 1. Nationwide, 41 million Americans rely on that program to pay for groceries, according to the Center on Budget and Policy Priorities.

Sister Mary Haddad, president and CEO of the Catholic Health Association of the United States, said Congress and the administration “have an obligation to ensure that those who depend on these vital programs are not left to wonder where their next meal will come from.”

“The inability to work together in a bipartisan way is not just a political failure — it’s a moral one,” Haddad said in a statement Thursday. “It directly harms low-income moms, children, working families, seniors, and individuals across the nation. Hunger is not a partisan issue.”