Will the United States pass on telemedicine progress?

• Published in: JAMIA open 2024-04, Vol.7 (1), p.ooae016-ooae016
• Main Authors: Cummins, Mollie R, Ivanova, Julia, Ong, Triton, Soni, Hiral, Barrera, Janelle F, Wilczewski, Hattie, Welch, Brandon M, Bunnell, Brian E
• Format: Article
• Language: English
• Subjects: Epidemics; Fraud; Health care reform; Medicaid; Medical policy; Safety and security measures; Telemedicine
• ISSN: 2574-2531; 2574-2531
• DOI: 10.1093/jamiaopen/ooae016

Background During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Methods Here, we argue that we must continue the flexibilities to better understand telemedicine’s quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. Conclusion We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine’s quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making. Lay Summary During the COVID-19 pandemic, there were temporary flexibilities in federal and state health policies, rules and regulations that enabled widespread telemedicine use. The United States has realized the potential in improving access to healthcare by integrating telemedicine alongside traditional, in-person healthcare delivery. However, many of the policy flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023. The United States has not made permanent decisions about telemedicine policy in the post-pandemic era. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Here, we argue that we must continue the flexibilities indefinitely until we better understand telemedicine’s quality, safety, and outcomes, and the United States can develop an evidence-based digital health strategy. In the context of explosive growth in digital health, a premature regression to pre-pandemic telemedicine policies risks unintended consequences, could prevent us from truly understanding telemedicine quality, safety, and outcomes, and would complicate regulatory decision-making for years to come. We must continue the current policy flexibilities, safeguard against