Using Punctuated Equilibrium Theory: Policy Momentum in Traditional Medicare Telehealth Reimbursement During COVID-19

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes.