A large clinical trial has confirmed that telehealth is just as effective as in-person visits for improving quality of life in patients needing palliative care. The study, which involved 1,250 lung cancer patients across 22 U.S. sites, found no difference in outcomes between the two groups—strengthening the case for permanent telehealth policy reform.
With Medicare’s pandemic-era telehealth flexibilities due to expire in late 2024, researchers and advocates are urging Congress to extend or cement these changes. Lee Schwamm, MD, co-author of the study, says the findings provide much-needed evidence for lawmakers to support ongoing access to virtual care.
Telehealth’s Rise—and Regulatory Uncertainty
Before COVID-19, Medicare offered limited telehealth reimbursements, mostly restricting access to patients in rural areas using approved facilities. But once the pandemic hit, those rules were temporarily lifted, prompting a skyrocketing increase in telehealth use—from 5 million Medicare visits in late 2019 to over 53 million in the same period in 2020. Private insurance also saw a 766% rise in telehealth usage.
Now, lawmakers are reviewing 15 proposed bills on telehealth policy—an event some have dubbed the 2024 “telehealth Super Bowl.” Providers warn that if Congress doesn’t act, a rollback in virtual care access could significantly affect patient convenience and healthcare equity.
Equal Outcomes, Greater Convenience
In the clinical trial, half the participants received telehealth-based palliative care after an initial in-person consultation; the other half had all sessions in-office. Researchers used a quality-of-life survey (FACT-L) and found no meaningful differences between the two groups. Satisfaction, mood, and caregiver well-being were also similar.
Interestingly, fewer caregivers joined virtual visits—likely because patients no longer required transportation support. Experts noted this highlights the independence and flexibility telehealth affords seriously ill patients.
The Broader Impact
Experts suggest this model could help narrow healthcare disparities, especially for patients with chronic conditions or those in underserved areas. For many, the option to see a doctor from home makes care more manageable and sustainable.
Expanding Access to Palliative Care Through Telemedicine
There is a severe global shortage of palliative care doctors, and access is often limited to major academic medical centers. According to the World Health Organization, only 10% of people worldwide who need palliative care actually receive it. This shortage creates significant geographic and economic disparities.
Telehealth offers a way to close this gap. Patients with serious illnesses—often too weak to travel—can now receive quality care from home. “In-person visits can be incredibly burdensome for palliative care patients,” says Dr. Winer, adding that telemedicine delivers equivalent benefits without requiring travel.
Telehealth’s Broader Impact on Acute and Chronic Care
Telemedicine's value extends well beyond palliative care. It is being used effectively for mental health, chronic conditions, and even emergency situations like strokes. For example, the FAST Act of 2018 permanently expanded Medicare coverage for telehealth stroke care, acknowledging the critical role of real-time virtual access to neurologists in saving lives and improving recovery.
Policy Push: Making Telehealth Coverage Permanent for Medicare
Researchers and clinicians are urging Congress to continue and expand Medicare reimbursement for telehealth services. Some policymakers worry that telemedicine might provide lower-quality care, but clinicians such as Dr. Kozhevnikov argue that virtual care often matches or even exceeds the quality of in-person visits—especially for palliative care patients.
There are also concerns about fraud, but a 2022 HHS report confirmed that telehealth abuse during the pandemic was rare, and effective safeguards already exist to monitor misuse.
The Cost Debate and the Telehealth Expansion Act
A key issue is cost. The Congressional Budget Office estimated that the Telehealth Expansion Act (H.R. 1843) could cost over $5 billion over 10 years. To control spending, some policymakers propose reimbursing telehealth at a lower rate than in-person visits.
However, leaders like Dr. Schwamm caution that underpaying for virtual care could discourage adoption—especially when significant up-front investments are required to build and support hybrid care models. Hospitals need time and funding to repurpose facilities, upgrade video platforms, and shift staff resources accordingly.
To balance access and fiscal responsibility, Schwamm proposes a phased reimbursement model: Medicare would pay at current rates initially, then gradually lower payments as infrastructure matures and the costs of delivering telehealth decline.
A Call to Action from the Medical Community
Experts stress the need to advocate for vulnerable patients—especially those who are homebound or live far from care centers. Telemedicine is a critical tool for reaching them.
“We must ensure patients and caregivers have continued access to these services,” says Dr. Kozhevnikov. “High-quality care should not be limited by distance or illness. Telehealth makes that possible.”
