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The ongoing government shutdown is causing widespread disruption to telehealth services, particularly for Medicare patients, as the fate of expired COVID-19-era flexibilities remains uncertain. After three weeks, it's leading to many healthcare providers scaling back or pausing telehealth services due to payment uncertainties and compliance risks.
Stakeholders like the American Telemedicine Association say the uncertain state of telehealth coverage for Medicare patients has led to increased patient cancellations and unnecessary in-person visits that exacerbate the strain on an already overburdened healthcare system.
It has the potential to force more patients into delayed care or emergency rooms during the fall and winter seasons when healthcare usage is generally increased. ATA also expressed concern over the fate of soon-to-expire e-prescribing rules for controlled substances.
We sat down with Kyle Zebley, senior vice president, public policy, at the ATA and executive director of ATA Action, to talk more deeply about the shutdown's effects on telehealth providers and patients – and the next wave of pain that might come for them.
"We are being negatively impacted to a severe degree, despite the fact telehealth has earned bipartisan support," Zebley told Healthcare IT News on Tuesday. "Every day that goes by, it's worse."
Widespread provider disruption
Without federal telehealth coverage for the Medicare population, an increasing number of health systems and providers are scaling back on virtual care services.
"Our members are experiencing increased patient cancellations, no-shows or unnecessary in-person visits and are having to reallocate staff to mitigate additional workforce challenges," Alexis Apple, director, federal affairs, at the ATA and head of government affairs at ATA Action, said in a statement on Oct. 24.
More health systems continue to say they no longer can deliver telehealth services to Medicare patients who need it and have relied on it.
The University of Iowa Healthcare is now warning patients that telehealth appointments might not be covered due to the government shutdown, according to ABC affiliate Kcrg.com. In Iowa, approximately 680,000 Medicare recipients rely on telehealth services, according to the story.
Again, stakeholders are urging action to protect patients.
"This will only continue to get worse as the shutdown continues," Apple warned.
Larger health systems share her concerns.
"Seeing the government shutdown stall our telehealth progress has been deeply disheartening and disruptive," added Dr. Helen Hughes, medical director in the office of telemedicine at Johns Hopkins Medicine and a member of ATA’s Center of Digital Excellence.
"As we watch vital access to care slip away, we hope Congress will act swiftly to permanently restore these essential services for our patients."
With government agencies operating under contingency plans, agencies can't progress any further on telehealth claims processing beyond what's allowable outside of the COVID-19-era flexibilities that expired the day before the shutdown.
"We urgently need clear guidance from the Centers for Medicare and Medicaid Services and Congress on extensions for the Medicare telehealth flexibilities and retroactive payment for telehealth claims to address mounting uncertainties and reassure providers and patients about the future of virtual care," Apple stated.
Hurting patients and caregivers
Zebley explained on Tuesday that telehealth stakeholders are asking for immediate attention because already overstretched health systems are not easily absorbing the quantities of telehealth visits switched to in-person appointments.
"You'll be lucky to see somebody in person in the next couple of months," he said. "And if it's something more acute … take a ticket and get into the back of the line in the emergency room."
Every fall and going into winter, the healthcare system prepares for the start of flu season, as well as other recurring stressors, Zebley noted.
The timing of the shutdown does not bode well for population health trends.
"This couldn't come at a worse moment in terms of a healthcare system under duress, overstretched with too little capacity, and we're exacerbating that at the worst possible time," he said.
"Most provider organizations are holding Medicare claims, to avoid the risk of nonpayment and compliance uncertainties – and remain divided on whether to continue telehealth, pause virtual services or transition back to in-person care, should the shutdown persist, which unfortunately looks likely," Apple said previously in a statement.
ATA and telehealth stakeholders are, however, still hopeful for retroactive reimbursement for providers that are delivering telehealth care during this time, Zebley said.
A newsletter update from CMS to all Medicare Administrative Contractors, reminding them that eligible telehealth claims for behavioral and mental health services are being processed during the shutdown, was welcome.
"Telemental health is still a permanent feature of the Medicare program, even with this ongoing lapse," Zebley said.
But, "the rub is, and the wrinkle is on, what about new patients who would have been established this month, and what type of providers can offer these services?"
Telehealth is collateral damage
Zebley then described deep concern over the government's role – the lawmakers and the administration.
"We are being negatively impacted to a severe degree," Zebley continued. "Despite the fact that nobody is out, as I always say, to get us, there is no opponent. [But] we'd be in a much better place if the lapse ended."
"Here in Washington, D.C., this is because of the high degree of partisanship and finger-pointing," he said. Telehealth is just one of many communities "that is being negatively hurt by the dynamics around the government shutdown."
The American Federation of Government Employees released a statement on Monday urging the government to reopen to essentially avert destroying itself and the people it serves, he noted.
"Unfortunately, shutdowns have become a recurring tactic in Washington," AFGE said in its statement. "But there is no 'winning' a government shutdown. They cost taxpayers billions, hurt small businesses and erode confidence in government itself."
These compounding problems could push a resolution on the current stalemate in Congress stemming from the U.S. Senate's failure to pass a resolution to fund the federal government on Sept. 30.
"We take each of the parties and all of the major leaders, including President Trump, and the congressional leadership of both parties in both chambers, at their word," Zebley said. "We know they're very sincere in their support for us. We'll never take that for granted; we're so appreciative of it.
"And yet here we are just crying out for help," he added. "It's a real shame for me as a student of politics of how this city works. No way to run a country, or a healthcare system."
Potential e-prescribing lapse
As the government shutdown enters its fourth week, ATA said it is also concerned about the e-prescribing lapse on the horizon.
In 2024, the Drug Enforcement Agency and the Department of Health and Human Services jointly extended virtual prescribing for controlled substances through the end of 2025.
Without a permanent framework in place, those could lapse, Zebley said on Tuesday.
"There's nothing about a shutdown that precludes the authority of the administration to extend the waiver," he noted. "We're calling on them to do it today, now."
As far as the organization knows, the shutdown is likely impacting the agencies' collective ability to move forward with their work to resolve telehealth prescribing rules and create special registries for virtual controlled substance prescribers.
"President Trump put this waiver in place five and a half years ago, and was kept in place by President [Joe] Biden and has been kept in place to date by President Trump," Zebley said. "So we're hopeful that this access to care continues."
He added that knowing ahead of time in September what would happen to telehealth and virtual care waivers if the government shut down without an extension did not stop it from happening.
"The kind of pain, and the theater, which had real-world impact, was allowed to happen anyhow," said Zebley.
That could also be the case with the e-prescribing flexibilities patients rely on, he said.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
