An Important Report From the Government Accountability Office (GAO)

A new report from the GAO titled, “COVID-19 Program Flexibilities and Considerations for Their Continuation,” investigates the future of telehealth and CMS waivers issued during COVID. The future is yet to be determined.

The GAO’s findings from these reports are related to Medicare and Medicaid flexibilities during the COVID-19 pandemic, as well as preliminary observations from ongoing work related to telehealth waivers in both programs.

In the 27-page report, the GAO office reports that while telehealth services expanded access to care during the pandemic, the full effect of services on cost, safety, and clinical outcomes hasn’t been determined.

“The quality of telehealth services provided to Medicare beneficiaries has not yet been fully analyzed, and evidence from the few existing studies is inconclusive.” The report was prepared by Jessica Farb and Carolyn Yocom. “According to (the Medicare Payment Advisory Commission), some researchers have concluded that, in addition to increasing access to care, telehealth can also improve the quality of care. Other researchers caution that the convenience of telehealth could harm the quality of patient care. (Centers for Medicare & Medicaid Services) officials told us in February 2021 that they are still exploring how to measure the quality of care when services are delivered via telehealth.”

During the pandemic, CMS issued more than 230 Medicare waivers. “Medicare telehealth waivers resulted in increased utilization of telehealth services, and provided beneficiaries access to services that would not have otherwise been available during the early days of the COVID-19 pandemic,” the report says. “However, the long-term effect of these waivers on spending and quality of care is not yet known. In addition, we reported that careful monitoring and oversight is warranted to prevent potential fraud, waste, and abuse that can arise from these new waivers. Existing research and preliminary observations from our ongoing work indicate the following effects of telehealth waivers on service utilization and access to care.”

More than 600 Medicaid waivers, state plan amendments, and other flexibilities were approved by CMS. The GAO concerns are in four key areas:

  1. Spending
  2. Program integrity
  3. Beneficiary health and safety
  4. Equity

This is a must-read report that covers:

  1. What is known about the effects of Medicare waivers on the Medicare Fee-for-Service program;
  2. What is known about the effects of Medicaid waivers and flexibilities on the Medicaid program; and
  3. Considerations for the ongoing.
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