Telehealth gets ‘win-win’ in budget package

It took some time, but telehealth providers finally secured a long-desired victory.

When President Trump and Congress agreed on the $1.2 trillion spending package, they included provisions that extend Medicare waivers for telehealth programs.

The package calls for a two-year extension for telehealth programs, with waivers lasting until the end of 2027. It also includes an extension of nearly five years for hospital-at-home programs, running through September 2030.

Kyle Zebley, chief executive officer of the American Telemedicine Association, tells Chief Healthcare Executive® that the package offers assurance for health systems operating telehealth programs and the patients using them.

“It means that something that has been available to Medicare beneficiaries for six years will continue for another two years,” he says.

“It means that something that the average Medicare beneficiaries come to trust and rely upon, something that's clinically appropriate, that expands access to much-needed care, something that expands capacity in the healthcare system that’s under strain, too many patients requiring too much care, but from too few providers … it means that persists,” he says. “It means that a calamitous consequence of allowing this to lapse again or permanently taken away, doesn't occur.”

Health systems and other providers were worried about another interruption to telehealth programs in the event of a lengthy government shutdown. Telehealth waivers have been attached to short-term spending bills, and the waivers have lapsed when those spending bills expired. When the government shut down last fall, telehealth programs faced significant disruptions and hospital-at-home programs had to move patients to brick-and-mortar facilities.

Now, Zebley says the goal is to secure permanent reforms for telehealth and hospital-at-home programs. So while healthcare advocates are enjoying the victory, they hope to build on their success.

“We're excited by it, and it gives us some breathing space,” Zebley says. “But, you know, we're still going to be fighting tirelessly to make this permanent.”

Offering more certainty

Rick Pollack, president and CEO of the American Hospital Association, tells Chief Healthcare Executive that it was “important” for Congress and the White House signed off on the telehealth extension. He points to the expansion of telehealth and hospital-at-home programs since the COVID-19 pandemic. ‘

“They were innovations that now have become standard practice in many ways for a lot of folks,” he says.

Pollack says the five-year extension for hospital-at-home programs could spur more health systems to consider providing acute care at home. The American Hospital Association has said that the uncertainty around long-term federal support for hospital-at-home programs has deterred some systems from launching such programs.

“There's no question that people were concerned about the long-term policy in this regard, and how unpredictable things could be in Washington in terms of policy,” he says. “And I think a lot of people were waiting to see, is this going to get locked in or not? Now, we were always confident politically that it would … but until it's done, and there's a firm signal, you know, people definitely were taking a wait-and-see attitude.”

Nationwide, 373 hospitals (in 140 systems) have received federal approval to operate home hospital programs, according to data from the Centers for Medicare & Medicaid Services.

Zebley points to hospital-at-home programs offering advantages to patients by allowing them to recover in a familiar environment, while freeing up beds for patients who need to be in hospitals.

“That's exactly the direction that CMS should be taking and getting folks out of hospitals and still ending their convalescence in coordinated care in the comfort of their own home,” Zebley says. “That's a win-win for our health care system, it is a win-win for patients, because our hospitals are oftentimes at a capacity breaking point, as the pandemic showed.”

Zebley says he suspects health systems leery of launching or expanding home hospital programs may now have the confidence to move forward with an extension lasting nearly five years.

“We have half a decade, the rest of the 2020s, into 2030, for predictability, for healthcare systems that have a wide variety of very hard choices to make, to make the right choice, to invest and innovate in this program,” he says.

“That again, directly positively impacts patients and communities across the country, and it was the exact right move,” he adds. “Obviously, we would have loved permanency, but short of that, five years is about as best as we could have hoped for.”

• Read more: Home hospital programs in rural areas see good results

Pushing for permanency

While Zebley and other telehealth advocates are indeed relishing the extension of telehealth programs, he says they will waste no time in pushing lawmakers and the Trump administration to approve permanent reforms for telehealth and hospital-at-home programs.

President Biden’s administration and Congress signed off on a two-year extension of telehealth programs that ended Dec. 31, 2024. But health systems endured a series of temporary extensions tied to short-term spending bills lasting for only a few months, creating anxiety for providers and patients.

With health systems having six years of experience providing virtual care since the start of the COVID-19 pandemic in early 2020, telehealth proponents and providers now have an easier sell to Congress, because there’s a proven track record, Zebley says.

“We know from our clinicians, from our providers, from our health care systems, that this is credible,” Zebley says. “It works. It can deliver, does deliver, high quality care.”

Telehealth continues to enjoy strong bipartisan support in Congress. Zebley also credits the Trump administration with “visionary” support for telehealth programs, including strong lines of communication.

He also points to the new $50 billion Rural Health Transformation Program, which was launched last year. He pointed to Dr. Mehmet Oz, the CMS administrator, who called on states to develop novel approaches to serving rural areas. Zebley says states got the message that telehealth programs needed to be a part of their plans.

“Dr. Oz and CMS and the administration put out if you're going to get this money, you needed to make sure that innovative, technological solutions to include all areas of virtual care, digitally-enabled care, were part and parcel of the application process,” Zebley says.

Now, Zebley is hoping to capitalize on the support for telehealth to lock in lasting changes. “We're still just going right back at it,” he says.

“We're elated to see the strong sign of support in a Congress that is often loath to make permanent decisions in so many areas. So this is about as good a deal as we could have expected, and we’ll still keep on fighting for permanency,” Zebley says.

“And I want President Trump to sign that bill, because it would be such a fitting cap to his legacy on these issues,” he adds. “Because it was his leadership that put this in place on a bipartisan basis six years ago at the beginning of the pandemic.”