Why is the government risking a return to a healthcare regulatory regime that results in worse outcomes, less access to care and higher costs?
The motives are unclear, but that would be the outcome if Congress lets the current regulatory framework for telehealth and hospital-at-home lapse, which it will if not renewed this year.
Telehealth and hospital-at-home have long held a promise of improving healthcare. As the 2010 National Broadband Plan detailed, telehealth offers “the potential to improve healthcare outcomes while simultaneously controlling costs and extending the reach of the limited pool of healthcare professionals. Furthermore, as a major area of innovation and entrepreneurial activity, the health IT industry can serve as an engine for job creation and global competitiveness.”
The plan also found that the existing legal framework, including state laws, insurance reimbursement and other requirements, created barriers to telehealth use.
Similarly, decades of research demonstrate that hospital-at-home is a safe, effective, and preferred method of care. For example, the Centers for Medicare & Medicaid Services’ 2024 report to Congress on the CMS Acute Hospital Care at Home waiver found hospital-at-home patients have dramatically lower nursing home use post-discharge, lower mortality even for clinically complex patients, and higher satisfaction. CMS also reported that hospital-at-home lowers Medicare spending for services 30 days post-discharge.
Nonetheless, the legal framework making virtual-forward care difficult largely stayed in place until March 2020.
With the COVID-19 pandemic, the incentives to act overwhelmed the status quo. The federal government, to its credit, moved quickly to ensure hospitals and health systems could leverage telehealth to respond efficiently and effectively to a wave of healthcare needs without putting patients at greater risks. These actions included CMS waiving certain regulatory requirements and Congress providing legislative support to ensure hospitals and health systems could rapidly and cost-effectively deploy virtual services and move patients from hallways and parking lots to their homes.
None of it was permanent. Instead, the government acted through multiple waivers. Congress passed the most recent waivers at the end of 2024, but those are set to expire on March 31, 2025. In addition, CMS has issued other temporary telehealth waivers that, without further action, will expire on Dec. 31.
The arguments to extend the waivers, as laid out in a letter from more than 350 healthcare organizations, are powerful. Extensions will:
—Provide certainty for Medicare and Medicaid beneficiaries to maintain access to clinicians and services they are using virtually and to hospital care at home.
—Strengthen our healthcare workforce by enabling more clinicians to provide needed services and allowing for investment in flexible, virtual staffing models that address workforce shortages while maintaining high-quality healthcare.
—Encourage investment in the technology and infrastructure needed to offer telehealth and hospital-at-home services, particularly for providers serving underserved communities that cannot afford to invest in these tools without an ensured reimbursement pathway.
—Allow health plans and employers to design and offer benefits leveraging telehealth and hospital-at-home services.
Rhetorically, the administration appears to agree. It emphasizes the need for greater efficiency, which telehealth provides. President Trump’s Executive Order establishing the Make America Healthy Again Commission calls for “expanded access to telehealth, especially in rural and underserved communities.” Health and Human Services Secretary Robert F. Kennedy Jr., in his confirmation hearing, pointed to “telemedicine with AI” as a way to increase the quality of care for Medicare and Medicaid recipients while reducing costs. He expressed his commitment to ensuring the availability of hospital care at home.
With deadlines approaching, rhetoric is not enough. Congress and CMS must act to extend these waivers in a longer-term and more meaningful way than including them in short-term continuing resolutions. Further, the government should continue to push forward with other changes, particularly for rural patients, such as eliminating the requirement that patients first come to distant and often overcrowded hospitals as a prerequisite to becoming hospital-at-home patients. We should take advantage of new communications technologies and American ingenuity to make healthcare better and cheaper for all.
