CTeL Engages HHS on Key Digital Health Priorities

The Center for Telehealth and eHealth Law (CTeL) recently met with senior advisors from the Immediate Office of the Secretary at the Department of Health and Human Services (HHS) to discuss crucial policy recommendations aimed at making digital health access permanent for all Americans. CTeL presented three key areas for the agency's immediate attention: accurately assessing the budget impact of telehealth, declaring a public health emergency due to the clinical workforce shortage, and enhancing oversight of the National Provider Identifier (NPI) to combat fraud.

Accurately Assess Telehealth's Budget Impact to Make Waivers Permanent

CTeL respectfully asked HHS to collaborate with Congress to accurately assess the budgetary impact of telehealth on Medicare, advocating for the permanent extension of Public Health Emergency (PHE) telehealth waivers. Two critical telehealth flexibilities are set to expire this year: the expansion of Medicare telehealth allowing beneficiaries to access services regardless of location, and telehealth prescribing flexibilities for controlled medications issued by the DEA.

Historically, in 2001, the Congressional Budget Office (CBO) estimated that expanding telehealth access would increase Medicare spending by $150 million over five years, leading to the implementation of originating site barriers to control costs. However, CTeL highlighted recent research demonstrating that telehealth is increasingly a substitute for in-person care, not an additive cost. This counters the long-held belief that telehealth leads to overutilization or dual use of both telehealth and in-person care for the same service.

Recent studies from 2025 support telehealth as a cost-effective, and potentially cost-saving, service:

• "Cost Impact of Telehealth: A National Analysis of COVID-19 Data" (Goldwater, Harris, 2025) found that telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000 to $181 million for Medicaid.

• "Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries" (Ganguli, Lim, Daley, et al., 2025) suggested that telemedicine adoption was associated with modestly lower use of some low-value tests and did not contribute to increased spending.

• "Telehealth and Outpatient Utilization: Trends in Evaluation and Management Visits Among Medicare Fee-For-Service Beneficiaries, 2019-2024" (Lee, Chun, Chang, et al., 2025) indicated that broad telehealth adoption has not led to increased healthcare utilization among Medicare FFS beneficiaries.

• "Association Between Telehealth Use and Downstream 30-Day Medicare Spending" (Ellimoottil, Kulkarni, Zhu, 2025) revealed that telehealth-initiated episodes of care were associated with lower 30-day Medicare spending and reduced utilization of labs and imaging.

These findings, along with other studies from 2022 and 2023, strongly suggest that telehealth acts as a substitute for in-person care and does not result in additional primary care visits or increased downstream utilization.

Declare a Public Health Emergency for the Clinical Workforce Shortage

CTeL strongly advocated for HHS to declare a Public Health Emergency (PHE) to address the severe national healthcare workforce shortage. The Health Resources Services Administration (HRSA) projects a deficit of 187,130 physicians and 207,980 nurses by 2037. This shortage leads to increased caseloads, burnout, longer patient wait times, and compromises the effectiveness of telehealth.

Nurses, who are essential to telehealth, face educational restrictions that worsen the shortage. The physician workforce is similarly limited by federally capped residency slots, resulting in many qualified medical graduates going unmatched. CTeL emphasized that while telehealth aims to enhance care access, its potential is compromised by an insufficient supply of healthcare providers, as there is "no virtual care without actual providers". An HHS declaration of a PHE would elevate the urgency of the issue and encourage states and Congress to address these structural limitations.

Enhance National Provider Identifier (NPI) Oversight to Combat Fraud

CTeL raised concerns about the growing issue of National Provider Identifier (NPI) fraud, where malicious actors use publicly available provider NPIs to fraudulently bill Medicare and other insurers for services. This fraud can lead to significant financial liabilities for providers and even loss of licensure, further exacerbating the workforce shortage.

To combat this, CTeL proposed that the Centers for Medicare & Medicaid Services (CMS) create a system, similar to a credit report, allowing clinicians to self-audit how their NPI is being used. This tool would increase transparency and enable providers to proactively report suspicious activity, such as billing outside their licensed state or scope of practice. CTeL urged HHS to work with CMS's Center for Program Integrity via the Victimized Provider Project to advance this initiative. It's important to note that telehealth is not inherently more prone to fraud than in-person care, and robust monitoring mechanisms can prevent system-wide fraud.

This discussion followed the recent swearing-in of HHS Deputy Secretary Jim O’Neill, who the advisors indicated would be particularly interested in addressing these areas. Additionally, HHS representatives mentioned that the agency is currently considering updates to the HIPAA Security Rule, as the comment period for the Biden Administration’s proposal has recently concluded.

As HHS focuses on chronic disease management and enhancing preventive care, CTeL believes that telehealth, remote monitoring, artificial intelligence, and other emerging health technologies will be essential in making healthcare more connected, effective, and affordable. CTeL remains committed to advocating for evidence-based policies that support the digital health community in achieving these objectives.

References

Bernstein, P., Ko, K. J., Israni, J., Cronin, A. O., Kurliand, M. M., Shi, J. M., Chung, J., Borgo, L., Reed, A., Kosten, L., Chang, A. M., Sites, F. D., Funahashi, T., & Agha, Z. (2023). Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study. Journal of Telemedicine and Telecare, 29(7), 566-575. 

Cao, Y. J., Chen, D., & Smith, M. (2023). Use telehealth as needed: telehealth substitutes in-person primary care and associates with the changes in unplanned events and follow-up visits. BMC Health Services Research, 23(1), 426. 

Dixit, R. A., Ratwani, R. M., Bishop, J. A., et al. (2022). The impact of expanded telehealth availability on primary care utilization. npj Digital Medicine, 5, 141. 

Ellimoottil, C., Kulkarni, A. J., Zhu, Z., Dunn, R. L., Chang, C.-H., Chun, E., Hou, H., Lee, J. D., McCullough, J. S., & Thompson, M. P. (2025). Association between telehealth use and 30-day Medicare spending. medRxiv. 

Ganguli, I., Lim, C., Daley, N., Cutler, D., Rosenthal, M., & Mehrotra, A. (2025). Telemedicine adoption and low-value care use and spending among fee-for-service Medicare beneficiaries. JAMA Internal Medicine, 185(4), 440-449. 

Goldwater, J., & Harris, Y. (2025). Cost impact of telehealth: A national analysis of COVID-19 data. Telemedicine and e-Health, 31(6), 772-778. 

Karam, M. F., Mian, O., & Sarfraz, R. (2023). Lack of evidence for telehealth fraud. Journal of the American Medical Informatics Association, 30(7), 1362–1363. 

Lee, J. D., Chun, E., Chang, C.-H., Liu, T., Dunn, R. L., McCullough, J. S., Thompson, M. P., & Ellimoottil, C. (2025). Telehealth and outpatient utilization: Trends in evaluation and management visits among Medicare fee-for-service beneficiaries, 2019-2024. medRxiv. 

Office of Inspector General. (2022). Medicare telehealth services during the first year of the pandemic: Program integrity risks. U.S. Department of Health and Human Services. 

Patel, S. Y., Mehrotra, A., & Huskamp, H. A. (2022). Comparison of quality performance measures for patients receiving in-person vs telemedicine primary care in a large integrated health system. JAMA Network Open, 5(9), e2231920. 

Roberts, T., Balzarini, B. A., & Salyers, M. P. (2022). Comparison of in-person vs. telebehavioral health outcomes from rural populations across America. BMC Psychiatry, 22(1), 785. 

Rubin, D. B., Han, S., & Conti, R. M. (2022). Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic. JAMA Psychiatry, 79(10), 972–982. 

Traudt, E. A., Lum, H. D., Daugherty, L. G., Lin, C. L., & Kao, D. P. (2024). Telehealth vs in-person early palliative care for patients with advanced lung cancer: A multisite randomized clinical trial. JAMA, 332(12), 1148–1156.