Category: Telehealth

In a move that surprised basically no one, the DEA is extending pandemic-era telehealth prescribing flexibilities for controlled substances through the end of 2025.

The “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” was officially published on November 19th, ending a months-long stalemate among regulators.

The third time’s the charm (hopefully). The extension gives providers another year to prescribe Schedule II-V medications for conditions like ADHD and opioid addiction without first conducting in-person evaluations.

• The move maintains the status quo that’s been in place since COVID hit, while effectively punting the decision on formal legislation to the new White House.

• Both the DEA and the HHS will have fresh leadership, and it remains to be seen how the two agencies will work together to address the matter.

The policy hot potato just got passed to the Trump administration, so telehealth companies and patients will both have to prepare for another year of regulatory limbo.

• By failing to issue a final rule, the DEA at least gains time to revise its most recent draft rules that sparked nearly 40k comments worth of industry pushback.

• Those rules included requirements that half of a provider’s controlled substance prescriptions be written for patients seen in-person, and that every patient must be checked against drug monitoring programs in all 50 states. 

It’s a classic tension in healthcare: balancing legitimate access against potential abuse.

• While the extension acknowledges the “urgent public health need” for access to addiction treatment meds like buprenorphine, the lack of legislation still leaves telehealth in a bucket of “stopgap measures” instead of “absolute necessities.”

• Punting the decision should also mean better guardrails can be developed to prevent abuse at a time when the founders of pandemic-era pill mills are either fleeing the country or forking over millions in fines.

The Takeaway

The telehealth prescribing can has been kicked down the road for another year, and the industry will now be watching to see whether the Trump administration decides to repeal it. It’s more likely than not that the extension will stick – this isn’t exactly a hot button issue like raw milk.

University of Michigan researchers just delivered some compelling evidence that telehealth doesn’t increase wasteful care, and may actually reduce it in several key areas.

This wasn’t a small study. The analysis in JAMA Network Open leveraged Medicare FFS claims data spanning 578k beneficiaries across 2,552 primary care practices between 2019 and 2022.

The researchers tracked eight measures of “low-value care” – services that provide little clinical benefit while racking up costs – across four categories: office-based, laboratory, imaging, and mixed-modality services.

The practices with the highest telehealth usage (top third) showed:

• Significant reductions in unnecessary cervical cancer screenings (-2.9 per 1,000 beneficiaries)
• Lower rates of low-value thyroid testing (-40 per 1,000 beneficiaries)
• No increase in wasteful imaging or other diagnostic services

Low-value care costs the healthcare system close to $100B annually, and while wasteful services have been extensively looked at using Medicare data, this was the first study to do so within the context of telehealth.

• On one hand, virtual visits eliminate chances for clinicians to perform low-value services that need to be performed in-person.

• On the other, it’s hard to imagine that the inability to conduct a physical examination won’t lead to more clinical uncertainty and low-value diagnostic testing, although that’s exactly what this research seems to disprove.

The Takeaway

This study tackles one of telehealth’s most persistent criticisms head-on, and the lack of a clear link between telehealth and low-value care should reassure policymakers weighing how to finance and regulate the segment going forward.

There’s no catalyst like a pandemic to transform virtual care from a niche offering to a must-have service, at least according to the 8,000 people who responded to Rock Health’s latest Consumer Adoption Survey.

Virtual care has become table-stakes for both patients and providers, with a majority of respondents using it within the past year (63%).

• A mature market doesn’t mean virtual care is for everyone. Almost a quarter of respondents still have never used it, citing preferences for in-person care (56%), quality concerns (18%), and lack of awareness (13%).

• Rock Health doesn’t expect adoption to ever reach 100%, and anticipates always needing a spectrum of omnichannel offerings – traditional, virtual, and retail – to meet consumers’ preferences and capabilities.

There’s a growing share of respondents that prefer virtual care over in-person care for use cases like prescription refills (69%, up 8pp) and mental health services (41%, up 3pp). [Chart]

• That isn’t too surprising given that refills are transactional care encounters, making them well-suited to low-touch virtual channels like app or portal messaging.

• Virtual mental health on the other hand reflects a changing status quo, where consumers want to choose from a wider range of providers with different identities or treatment approaches (especially relevant in mental healthcare), and can conveniently access them for regularly scheduled visits.

Consumers are drawn to convenience, but virtual care innovators will need to invest in additional value drivers like data security and user-friendliness to stay competitive.

• While convenience helped drive virtual care’s popularity, it also attracted competition from retailers, grocers, and CarePods that have the advantage of bundling healthcare with other routines like grocery shopping.

• For virtual care players, continuing to compete on convenience involves considering both when and where virtual is really more convenient than the best in-person offering, and when it makes sense to partner with retailers as opposed to competing on other differentiators.

The Takeaway

Rock Health’s survey makes it clear that we’re in a new era of virtual care, one that brings its own set of market pressures. Those looking to succeed will have to navigate new value propositions (what defines the best virtual care), alternatives (virtual care doesn’t have a monopoly on convenience or access), and as always, the regulatory/reimbursement landscape.