When the pandemic hit more than 2 years ago, nephrologists and their patients had to pivot on a dime to adapt to telehealth technologies. Those technologies have proved popular with both nephrologists and patients. But now, clinicians face new challenges as they try to develop sustainable and equitable hybrid telehealth and in-person care models for the long term.
Provisions in the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act enabled the Centers for Medicare & Medicaid Services to temporarily waive restrictions on where and how patients could receive telehealth (1). This policy change led to a rapid expansion of telehealth care. Before the changes, telehealth was allowed for patients on home therapies, such as home hemodialysis and peritoneal dialysis, through the Bipartisan Budget Act of 2018 (2). But there were restrictions on using telehealth for other kinds of kidney care. Medicare only covered telehealth visits in rural areas, and patients could not access telehealth visits from home. Audio visits were prohibited, and clinicians could only use Health Insurance Portability and Accountability Act-compliant video platforms. Clinicians were concerned the changes would expire with the end of the COVID-19 public health emergency. But in March 2022, Congress passed, and President Biden signed into law, a spending bill (3) that extended the provisions 5 months after the official end of the COVID-19 public health emergency.
“We commend the legislators for including critical telehealth extensions in this must-pass legislation, ensuring that patients do not fall off a ‘telehealth cliff’ immediately after the COVID-19 public health emergency ends,” wrote Kyle Zebley, vice president of public policy at the American Telemedicine Association (ATA), in a statement (4). But the ATA and organizations representing physicians, such as the American Medical Association (5), want legislators to make the policies permanent this year.
Public Law 116-123, 116th Congress. Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. March 6, 2020. https://www.congress.gov/116/plaws/publ123/PLAW-116publ123.pdf
Congress.gov. Public Law 115-123, 115th Congress. Bipartisan Budget Act of 2018. February 9, 2018. https://www.congress.gov/bill/115th-congress/house-bill/1892/text
Congress.gov. Public Law 117-103, 117th Congress. Consolidated Appropriations Act, 2022. March 15, 2022. https://www.congress.gov/bill/117th-congress/house-bill/2471
American Telemedicine Association. ATA and ATA action commend Congress for extending telehealth flexibilities post public health emergency to temporarily avoid the ‘telehealth cliff,’ but will continue to work with Congress on permanent solutions. ATA News. March 9, 2022. https://www.americantelemed.org/press-releases/ata-and-ata-action-commend-congress-for-extending-telehealth-flexibilities-post-public-health-emergency-to-temporarily-avoid-the-telehealth-cliff-but-will-continue-to-work-with-cong/
American Medical Association. The AMA salutes Congress for passing omnibus telehealth provisions. Press release. March 14, 2022. https://www.ama-assn.org/press-center/press-releases/ama-salutes-congress-passing-omnibus-telehealth-provisions
Congress.gov. 117th Congress. Telehealth Extension and Evaluation Act. Introduced February 8, 2022. https://www.congress.gov/bill/117th-congress/senate-bill/3593/text
Young A, et al. Video-based telemedicine for kidney disease care. CJASN 2021; 16:1813–1823. https://cjasn.asnjournals.org/content/16/12/1813
Eneanya ND, et al. Age and racial inequities in telemedicine internet support among nephrology outpatients during the COVID-19 pandemic. Kidney Med 2021; 3:868–870. doi: 10.1016/j.xkme.2021.05.001
Lin Q, et al. Assessment of structural barriers and racial group disparities of COVID-19 mortality with spatial analysis. JAMA Netw Open 2022 1; 5:e220984. doi: 10.1001/jamanetworkopen.2022.0984
Congress.gov. Public Law 117-58, 117th Congress. Infrastructure Investment and Jobs Act. November 15, 2021. https://www.congress.gov/bill/117th-congress/house-bill/3684/text