Telehealth Challenges & Trends as the COVID-19 Public Health Emergency Ends

Telehealth use soared after COVID-19 arrived on U.S. shores in 2020. During the lockdown, Congress and state legislatures loosened telehealth policies and laws to ensure healthcare access for millions of Americans. 

However, after the COVID-19 public health emergency (PHE) ended on May 11, 2023, not all telehealth flexibilities remained. The Consolidated Appropriations Act of 2023 extended many of the exceptions through Dec. 31, 2024, but providing patients continuity of care and reimbursement for telehealth beyond 2024 will require some policy changes. Here are some of the current challenges, trends, and opportunities for the telehealth industry this year.

Challenges for the Telehealth Industry

As the PHE ended, the U.S. Drug Enforcement Administration (DEA) proposed two rules that would reinstate a requirement for a patient to have an in-person visit with a healthcare provider in order to continue taking medications labeled as controlled substances.

The proposed rules would allow a 30-day supply of Schedule III-V non-narcotic controlled medications or a 30-day supply of buprenorphine for the treatment of opioid use disorder without an in-person visit. However, an in-person visit would be required after 30 days.

This requirement could potentially impose barriers on patients who built relationships with doctors via telehealth — and who may not live near their telehealth provider or have transportation challenges.

“It is going to sever continuity of care for countless Americans,” says Kyle Zebley, senior vice president of public policy at the American Telemedicine Association. “There’s no clinical purpose for these in-person requirements. And so we’re very hopeful that the DEA will reconsider, and we’re very concerned if they do not.”

Under Medicare, broader access to non-behavioral/mental telehealth services is set to expire at the end of 2024, as is allowing telehealth service by a physical therapist, occupational therapist, speech-language pathologist, or audiologist.

At the state level, Zebley says there are still far too many barriers to interstate care. During the pandemic, all 50 states allowed, in some capacity, healthcare providers to provide telehealth services across state lines in states where they were not licensed. However, after COVID-19 lockdown restrictions loosened and the federal PHE ended, not all states continued to allow this flexibility. Legislation varies from state to state, so it’ll be increasingly important for organizations in this sector to stay on top of proposed laws and emerging conversations across statehouses to ensure compliance.

Telehealth Trends to Watch

Despite the challenges, there are numerous opportunities for telehealth providers to continue broadening access to their services. More than 97 million people in the U.S. live in areas with a shortage of primary care professional healthcare. With an aging U.S. population, a shortage of providers, and staff burnout exacerbated during the pandemic, there are solid data and opportunities to advocate for greater telehealth access.

Before the pandemic, telehealth was focused on covering acute care — serving as an alternative to expensive emergency room visits. But as more affordable urgent care clinics opened up, telehealth shifted from acute care to chronic condition management, says Christa Natoli, executive director of CTeL, a nonprofit research organization focused on telemedicine and virtual care. That trend has continued in 2023, along with a new “star” that popped up during the pandemic, she said.

Remote Patient Monitoring (RPM)

That new trend is remote patient monitoring (RPM), which Natoli calls a “cousin” to telehealth. RPM allows healthcare providers to monitor vital signs and the condition of patients continuously in real time either in the hospital or at home. RPM can reduce hospital stays, better manage chronic conditions, and decrease emergency room visits, experts say.

“It’s not this time-and-place encounter anymore. It’s not like you just see the patient for their medical visit and then you don’t see them again until their next medical visit, either in person or virtually,” Natoli says. “You’re able to see this patient in real time continuously. … Usually, this is a high-risk chronic care patient … [and] you can triage a medical issue before it becomes something.”

Medicare requires RPM data to be collected for 16 days out of 30. Private insurers and each state have their own billing and monitoring requirements, so it’s a trend worth following at the state policy level.

Expanded Broadband Internet Access

Another trend that affects telehealth access is the continued need to expand broadband internet access, Natoli says. Many people in the U.S. don’t have access to Wi-Fi, or cannot afford it. In fact, 10 percent use prepaid phone plans that have a data cap, according to Natoli. Typically, one 30-minute telehealth video call would use up half of that limit. The 2021 federal infrastructure bill included funding to expand high-speed internet across the U.S., but it’s up to the states to implement it.

Keep Track of Telehealth Legislation

Telehealth use skyrocketed during the pandemic, but after the PHE expired, some restrictions have been reinstated. To navigate this changing landscape, FiscalNote, the only issues management platform built for health policy professionals, helps you stay on top of the industry's most pressing matters.

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