As a proud member of the AUA Telehealth Task Force, a telehealth policy researcher, and the Medical Director of Virtual Care at the University of Michigan, I had the distinct honor of representing both my insights and the broader perspective of the urology community during my testimony to the US Senate Committee on Finance, Subcommittee on Health Care, on November 14, 2023 (Figure). The hearing, entitled “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency,” was not only a career milestone for me but also a pivotal moment in the ongoing advocacy for telehealth services.¹

The pandemic-era flexibilities, such as the removal of geographic restrictions and the inclusion of audio-only coverage, played a crucial role in telehealth’s expansion. Currently, telehealth is well integrated into most urology practices, and numerous studies in our field have underscored its effectiveness and widespread acceptance.

However, this positive trend in telehealth faces potential disruption after December 31, 2024. Many of the pandemic-era flexibilities that have facilitated the widespread use of telehealth are set to expire on this date, absent proactive measures from Congress and the Medicare program. During my testimony on November 14, I emphasized various strategies Congress could adopt to prevent the “Fast and Slow Death” of telehealth. Specifically, I highlighted that a rapid decline, or “fast death,” of telehealth could occur if pre-pandemic geographic and site restrictions are reinstated on December 31, 2024. These restrictions would predominantly confine telehealth services to rural patients and prevent patients from connecting with their health care providers from the comfort of their homes. If this were to happen, we would likely witness an immediate and significant drop in telehealth usage.

The “slow death” of telehealth post–December 31, 2024, presents a more subtle yet equally concerning threat. This gradual decline could occur if patients and providers become increasingly frustrated with complex regulatory and billing rules, leading to disincentives to use telehealth services. To prevent this slow death, there are 4 key factors for Medicare and Congress to consider:

1. Coverage alignment across insurers: Medicare’s stance on telehealth coverage significantly influences other insurers. If Medicare treats expanded telehealth coverage as temporary, it will lead commercial payers to reduce or eliminate their telehealth services.
2. Cover audio-only services: The impact of the digital divide, particularly in rural and underserved areas, highlights the necessity of audio-only telehealth. Eliminating this option could disproportionately affect these communities, depriving them of essential health care access.
3. Ensure payment parity: There’s a common misconception that telehealth visits, particularly video visits, are less costly than in-person consultations. However, unless a practice is entirely virtual, overhead expenses for maintaining a physical office remain unchanged. Equitable reimbursement for telehealth services is vital to prevent a financial disincentive for providers.
4. Remove guardrails lacking clinical evidence: An example of an unnecessary guardrail is the recently postponed Medicare requirement for mental health providers to have in-person visits at specific intervals with patients they see virtually. This requirement lacks clinical evidence supporting its necessity. It’s crucial to evaluate and eliminate such guardrails that are not grounded in clinical efficacy.

During the hearing, we delved into the state of evidence regarding telehealth’s impact on access, quality, and costs for Medicare beneficiaries. In my written testimony, accessible on the hearing’s webpage,¹ I presented data illuminating the findings researchers have gathered over the past 3 years. While no single study can comprehensively capture telehealth’s entire impact on costs, quality, and access, there is a general consensus among researchers on these key points:

• Costs: The expansion of telehealth services over the last 3 years has not resulted in excessive health care spending or overutilization.
• Quality: The impact of telehealth on the quality of care varies depending on the condition, the telehealth modality, and the specific quality measures used. Generally, telehealth does not undermine the quality of care for patients.
• Access: Telehealth significantly improves access to health care services.

In the end, making telehealth expansion permanent is about ensuring that Medicare beneficiaries have choices in their care, whether it’s in-person, via video, or through a phone call. As we move forward, the insights and advocacy of groups like the AUA Telehealth Task Force will be invaluable in shaping a telehealth landscape that is beneficial for all–patients, providers, and the broader health care community.