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Telemedicine lobbying soars nearly 200% in push to capitalize on coronavirus pandemic and make permanent changes to Washington policy

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  • Doctors and patients are using telehealth at unprecedented levels compared with before the coronavirus pandemic.
  • The industry has already secured some big wins, including more federal funds and a loosening of concerns about safety and privacy — but there’s widespread concern and DOJ focus on medical fraud.
  • Spending on lobbyists for medical technology companies, telehealth startups, doctors’ groups, hospitals, universities and more has surged to at least $62 million in the first quarter of 2020.
  • Firms with a focus on sexual health treatments, mental health, chiropractors and more have hired representatives to lobby and promote their latest offerings in the new covid medical market.
  • Visit Business Insider’s homepage for more stories.

Telemedicine industry insiders who have long been pushing for the widespread adoption of the technology are scrambling to convince Congress and agency regulators that its vast use across the United States should remain the norm well after the coronavirus crisis subsides.

Because of the pandemic, years of policy disagreements have already been resolved in a matter of months. Now the industry is trying to turn its early wins into something more permanent that will keep pushing interactions between doctors, patients and their insurance companies onto a patch that catches up with the 21st century.

There’s a long wish list, and it includes more federal funding for less-connected areas of the US and to keep building off rule revisions like the recent ones that allows doctors to bill Medicare and Medicaid for video and telephone visits and for physicians licensed in one state to do online visits with patients in another. 

But while privacy and safety concerns have fallen away for apps like FaceTime and Zoom as they become go-to platforms for medical care during a pandemic, telemedicine still must contend with fraud concerns and ramped-up Justice Department scrutiny.

“There’s been a paradigm shift in the last three months of where telehealth policy is and where it’s heading,” said Sarah-Lloyd Stevenson, a former Senate GOP staffer who now lobbies Congress and the executive branch on behalf of a trade group representing major health care organizations and startups.

Dozens of technology companies, telehealth startups, doctors’ groups, hospitals, universities and other organizations spent at least $62 million in the first quarter of 2020 on lobbying, including on issues of telehealth and telemedicine, disclosures reviewed by Insider show. That’s a nearly 200 percent jump from the first quarter of last year.

Lobbying disclosures show a wide range of groups fighting to promote what they say are the benefits of telehealth. Newer startups established to treat sexual health problems are trying to help people triage Covid-19 symptoms. Trade groups representing firefighters, chiropractors, addiction specialists and physical therapists have jumped into the debate alongside longstanding doctors’ organizations like the American Medical Association and the American Telemedicine Association. The Pennsylvania Farm Bureau lobbied on telehealth expansion this year. So did the National Taxpayers Union.

Telemedicine has its critics, even in the current moment. Beyond the fraud potential come concerns about the lack of human interaction between a doctor and patient that can make for a more thorough visit, as well as licensing and billing issues when treatment happens across state lines. But a public health crisis can put even those factors in perspective, and telemedicine advocates have moved quickly to turn the situation into an opportunity.

“We don’t have to imagine or argue about whether telehealth makes sense anymore, we have a real-life emergency demonstration,” said Sen. Brian Schatz, a Hawaii Democrat who has been pushing telemedicine legislation long before the coronavirus pandemic. 

It wasn’t intentional, but Covid-19 has been a boom for the telemedicine industry. Even those who have not contracted the virus are now hesitant to visit doctors’ offices for routine care for fear of exposure. Check-ins for common colds and therapy appointments seem entirely sensible to do online instead of in-person. 

That’s what is driving unprecedented growth and traffic for telemedicine technology companies and prompting them to ramp up their lobbying presence in Washington. 

Teladoc Health, which retains Washington lobbying firm Mehlman Castagnetti Rosen & Thomas, reported visits increasing by 92% in the first quarter of 2020 and revenue increasing by 41% during the same time period. Doctor on Demand, another telehealth company, reported a 50% increase in demand. Companies like Amwell are adding new telehealth platform products for smaller physician practices. 

Other more traditional telemedicine companies are bringing on lobbyists for the first time amid the coronavirus pandemic, including Rhinogram, a cloud-based telehealth platform that registered three lobbyists from law firm Polsinelli PC in early May. Doctor on Demand registered with Faegre Drinker Biddle & Reath LLP in early May as well.

A March poll from Blackbook Market Research found that 59% of US consumers surveyed said they are more likely to use telehealth now than before the Covid-19 pandemic. Forty-four percent said telehealth services are currently available to them and 36% would switch physicians if it meant they had access to virtual care. 

“When I used to spend time discussing the importance of telehealth, it was largely in the abstract,” said Schatz. “Now, it’s a question of whether your mother can get a checkup safely, or if someone can get psychotherapy during the pandemic.”

The shift toward virtual medicine comes with caveats. Some experts worry about the efficacy of telehealth visits compared to in-person visits, and some companies are overwhelmed by demand. Doctors have reported struggling to figure out how to bill their services with the change in policies. There are also rampant concerns about fraud as telemedicine gets more common.The Justice Department charged dozens of people last year before the pandemic for stealing $2.1 billion from Medicare in a telemedicine venture.

Among the potential troublespot insiders are watching out for is healthcare reimbursement fraud, including where a doctor bills for services that never occurred or where an insured patient makes an appointment but then a non-insured person actually uses the service.

Dozens of agency policies have been changed for the duration of the pandemic in the US, ushering in huge spikes of telehealth use.

The federal agencies responsible for deciding policies around how doctors can be reimbursed and licensed for telemedicine moved in late March to loosen rules for telehealth. Lobbyists, trade associations and other industry watchers described the shift by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services as fights they had been having for years resolved in a matter of weeks.

The Federal Communications Commission secured $200 million through the CARES Act, a coronavirus stimulus package passed by Congress in March to fund telehealth services for health care providers. Medicare and Medicaid (though Medicaid policies vary by state) now are able to pay for telehealth visits the same way as in-person visits, which is a big deal because the two government programs combine to cover about a third of Americans. 

Security and privacy considerations for what technology doctors can use have also been changed, with doctors now permitted to use apps such as FaceTime, Skype or Zoom for virtual care.

The telemedicine industry is also getting some helpful advertising from the federal government.

A new website, www.telehealth.hhs.gov, encourages people to seek out telemedicine services. The CARES Act provides hundreds of millions of dollars for telehealth programs and infrastructure, and the law did away with a requirement from Medicare that doctors are licensed in the same state where they are offering telehealth services to a patient. The Drug Enforcement Administration also loosened remote prescribing restrictions. 

“It is shocking to me, in a good way, how far we’ve come in the past couple of months,” said Stevenson, now a director at Faegre Drinker Biddle & Reath LLP lobbying for the American Telemedicine Association.

Stevenson previously worked for Sen. Roger Wicker, a Mississippi Republican who’s been pushing for more telehealth reimbursement and expansion for years because wide swaths of his constituents live in rural areas without access to care. Stevenson also had a health policy portfolio at President Donald Trump’s White House. 

“If the feds flip the switch and it goes back to how it was, that’s not going to be a popular decision,” she said. “We need to be thinking right now about what happens after.”

In the American Telemedicine Association’s latest request to Congress, the group urges lawmakers to think about what happens after the pandemic is gone, specifically requesting permanent changes to U.S. law that make telehealth access more difficult.

“The value of and demand for telehealth will not end when this public health emergency ends,” Kevin Harper, the group’s director of public policy, wrote in a letter to Congressional leaders including House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell. “We must recognize that our ‘new normal’ following this limited COVID-19 public health emergency will necessitate patients’ and providers’ continuing to use telehealth to promote social distancing and to maximize health care resources.”

Some companies without a traditional Washington presence are also seeing an opportunity to connect with lawmakers to promote telehealth policy changes. 

Roman Health Ventures, Inc., which describes itself on its website as a “digital health clinic for men,” — though it has services for women, too — hired a top-tier Washington firm in April as the pandemic shut down the country.

While the company at first glance doesn’t appear to address medical issues directly tied to the pandemic  — it offers online visits where doctors will write prescriptions for erectile dysfunction, premature ejaculation, cold sores, genital herpes, hair loss and skincare treatments — it also has started a free telehealth triage assessment product for people across the US to check for Covid-19 symptoms. 

Adam Greenberg, general counsel at Ro, the parent company of Roman, said the company brought on Covington & Burling LLP’s policy team last month to get advice on a number of healthcare policy issues shortly after building its product.

Most of Roman’s policy initiatives are focused on the state level, while introductory conversations on Capitol Hill during the past two months have been for the purpose of educating lawmakers on the Covid-19 product and Ro Pharmacy, the company’s $5 per month cash-pay pharmacy.

“We’re getting to know policymakers at the federal level and introducing them to Ro as we continue to grow our national presence,” Greenberg said.

Morgan Reed, executive director of the App Association, a trade group that represents app companies, said his group has been fighting for telemedicine reimbursement and mobile monitoring of patients for years. He’s noticed a big change from before the pandemic, when Capitol Hill staff were worried about encouraging their bosses to support something expensive or not fully vetted.

“Right now, everybody is in support,” he said. “The question is what do we do when we’re through the next stage of this to keep everyone on board.”

Ashley Gold is a Washington, D.C.-based freelance reporter focusing on technology, health care and policy whose work has appeared in The Information, POLITICO and BBC News. Find her on Twitter @ashleyrgold.

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