AHA's Feedback to the House of Representatives Re: The CONNECT Act

January 30, 2023

Re: Feedback on the CONNECT for Health Act

Dear Representatives Thompson, Johnson and Schweikert:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to provide feedback on the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) Act, and to support Congress’ continued efforts to transform health care through permanent telehealth reform.

At the outset of the COVID-19 pandemic, the federal government moved quickly to ensure hospitals and health systems were able to respond efficiently and effectively to a wave of unprecedented need. These actions included the Centers for Medicare & Medicaid Services (CMS) waiving certain regulatory requirements and Congress providing significant legislative support to ensure hospitals and health systems could manage the numerous challenges facing them, including by an increased ability to administer virtual care. These swift actions provided hospitals and health systems with critical flexibilities to care for patients during what has been a prolonged and unpredictable pandemic.

Spurred in large part by these waivers and legislative support, virtual care and telehealth services have increased dramatically over the course of the pandemic. A report from the Department of Health and Human Services found that in 2020, telehealth services increased by over 51 million encounters, representing a 63-fold increase from 2019.1 There is a growing body of evidence to suggest that for the vast majority of specialties, telehealth services provided during the pandemic were not duplicative of in-person services. For example, most recently, a study of over 35 million records by Epic found that for most telehealth visits across 33 specialties, there was not a need for an in-person follow-up visit within 90 days of the telehealth visit.2 In many cases, telehealth served as an effective substitute for in-person care and did not result in duplicative care.

Expansion of virtual care has transformed care delivery, expanded access for millions of Americans and increased convenience in caring for patients. Given some of the current health care challenges, such as major clinician shortages, telehealth holds tremendous potential to leverage geographically dispersed provider capacity to support patient demand. We applaud efforts by Congress to reduce barriers to care delivery by extending many telehealth flexibilities through the end of 2024 as a part of the Consolidated Appropriations Act that passed in December 2022. Indeed, AHA continues to urge that certain of these telehealth waiver provisions be made permanent.

Since the CONNECT Act was first introduced in 2015, the landscape has changed significantly. For example, providers and patients have learned first-hand about application and benefits of technology in care delivery, and use of virtual care modalities is seen now as an expectation for many beneficiaries. As updated telehealth legislation is being drafted, we encourage sponsors to consider the lessons learned from the pandemic and additional provisions that have supported expansion of access to care via telemedicine during the state of emergency.

Specifically, we encourage the following.

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