Calls are growing louder to make permanent regulatory flexibilities for telehealth.

Pandemic-related telehealth waivers temporarily instituted by the U.S. Centers for Medicare & Medicaid Services (CMS) during the public health emergency have been extended several times. Currently they are set to expire on Sept 30. If they end as planned, hospice providers, as well as patients and families, could face potentially detrimental impacts, according to several hospice leaders.

The ability to develop and provide a sustainable model of virtual care for patients and caregivers will require a more permanent regulatory framework around telehealth utilization, Dr. Julia Frydman, senior medical director at Thyme Care, said at the Hospice News ELEVATE conference in Florida.

“We need to be making increasing investments in understanding how these care models work, and it is going to require permanent extensions to really understand who is appropriate for telemedicine and who really needs that in-person visit,” Frydman told Hospice News at the conference.

The most recent extension came last month with the Full-Year Continuing Appropriations and Extensions Act 2025. The law allows for continuation of several public health, Medicare and Medicaid authorities and programs. The continuing resolution preserved the flexibility allowing hospices to perform face-to-face recertifications through telehealth.

Hospice News photo by TBAR Productions.

The need for a regulatory framework

If the telehealth flexibilities were to become permanent, hospice providers could work to optimize these services rather than utilizing virtual care to augment in-person models, Frydman stated. Providers need a regulatory framework that addresses patient eligibility and sets care guidelines and quality standards, she indicated. Hospices could develop stronger collaborative care models if more solidified and permanent telehealth regulatory structures were set in place.

“It’s about the permanent regulatory environment, the continuing to enable end users to use the technologies, and then really thinking about the way in which we’re going to create hybrid models that include telehealth and also in-person components across hospice and other specialties,” Frydman said. “How those modalities are going to work together is the central clinical question that’s going to challenge us moving forward.”

Growing demand for hospice and staffing shortages are some of the forces driving greater demand for virtual care. Several studies have found that telehealth utilization among serious and terminally ill patient populations has been linked to improved care transitions, more effective in-person care delivery and coordination and greater caregiver support and better clinical capacity.

Telehealth utilization has also been an important part of improving health disparities among underserved patient populations, according to Bivak Pathak, chief information officer at Empath Health.

Current flexibilities have only scratched the surface of possibilities around virtual care in tandem with in-person services, Pathak said. Examining how these services have impacted health care delivery thus far will be key to understanding and shaping future telehealth regulations, he added.

“We definitely need more equitable access to telehealth, and for that reason [it’s about] how we support the advocacy and regulation perspective,” Pathak told Hospice News at the ELEVATE conference. “When we talk about [technology] integration, we don’t just talk about demographics coming into your telehealth solution. [There’s] regulatory uncertainty and reimbursement issues. We do see a marker moving the technology advancement and adoption is going, but we still have some work to do.”

Hospice News photo by TBAR Productions.

A key driving factor in favor of making telehealth flexibilities permanent in some fashion is that health care delivery for terminal and seriously ill patient populations has increasingly moved into home- and community-based settings, said Wendy Conlon, senior vice president of client experience, at the technology company Axxess.

Telehealth utilization can have a four-pronged impact when it comes to cost-effectiveness, clinical capacity, timely access and improved care coordination, according to Conlon. Greater integration of virtual care is needed in the face of increasing trends of patient preferences for home-based services, she added.

“Telehealth aligns with the quadruple aim [of] leveraging technology for quality patient outcomes, really looking at reducing cost, tapping into population health to allow trust and investment in technology [and] build out that access to seamless care from population health perspective,” Conlon said at the conference. “[It’s] really key to the future of care in the home. The speed of care, getting to the patient at the right time with the right level of care and thinking about how telehealth can absolutely leverage that opportunity.”

Hospice News photo by TBAR Productions.