The Effect of Telehealth on Spending

Telehealth faces an uncertain future. Without congressional action, broad reimbursement for telehealth in Medicare will expire at the end of 2024. Physicians and health systems have asked Congress to craft permanent policy. They argue that without a signal that telehealth will be available permanently, clinicians will not make the necessary investments to optimize these services. In other words, telehealth cannot deliver on its promise to improve access and quality if Congress does not commit. Yet despite these repeated and seemingly reasonable calls for lasting change, congressional activity in the spring of 2024 indicated that payment will be extended for just 2 years. To many, Congress' actions do not make a lot of sense. Clinicians and patients seem to value telehealth and its convenience. Why not give telehealth a permanent role in our delivery system? It boils down to money, and it is time to start talking about it. In high-level policy discussions about telehealth, various stakeholders have historically ignored or misrepresented the implications of telehealth expansion on spending. This entrenched approach has substantial downsides, confusing policymakers or making them distrustful of otherwise compelling arguments about telehealth's benefits. In this commentary, we argue that to make lasting progress on telehealth policy, we need a reframing of the discussion on costs.