August 6, 2020
by Michael Bagel and Ginny Whitman
The utilization of telehealth has skyrocketed as patients, providers and plans have quickly become reliant on telemedicine to deliver care in homes and other non-traditional settings in the midst of COVID-19.
But while there is broad consensus that telehealth is here to stay, significant questions remain about how to make it a permanent fixture in care delivery. Challenges exist in prioritizing value in virtual care services, easing restrictions in geography and site of service rules as well as expanding opportunities for clinicians and services within telehealth. In addition, significant efforts must be made to enhance access to telehealth – through broadband especially – and ensure patient data is protected.
Consumer demand, persistent health risks from the pandemic and the unsustainable cost of our health system present policymakers with a rare opportunity to make immediate and lasting impact.
Fortunately, Congress and the Administration are engaged in many of these areas, most helpfully in initiatives to make permanent several of the flexibilities extended to telehealth in Medicare under the public health emergency. As policymakers determine additional ways to enhance virtual care both now and in the long-run, here are 6 things they should consider immediately:
- Prioritizing value in virtual care: to achieve system-wide savings and ensure long-term sustainability, providers and health plans should transition to a value-based payment model that incorporates telehealth. Care delivered via value-based or capitated payments prioritize quality and appropriateness, resulting in more efficient and affordable care. Congress can support this by providing permanent telehealth flexibilities for health plans in federal programs and capitated arrangements such as Medicare Advantage.
- Easing restrictions on site of service and geography: under current regulations, seniors face challenges using telehealth from the convenience and safety of their own homes. Congress should ease these restrictions by revising Section 1834(m) of the Social Security Act which, restricts Medicare reimbursements for telehealth only when delivered at a qualifying originating site, typically a physician’s office, hospital, rural health clinic.
- Expanding providers and services in telehealth: the current Medicare program limits the types of clinicians eligible to deliver telehealth and further limits the technologies or devices that can be used to access telehealth. Most notably, restrictions that exclude telephones presents a significant barrier for many rural and older patients. Congress should provide HHS the authority to expand the list of providers allowed to deliver telehealth. CMS should develop a process, after collecting data on provider and patient experience, to determine the care appropriate for delivery via telehealth and remote monitoring and it should permanently allow telephones as a tool for virtual care.
- Expanding telehealth across state lines: greater adoption of telehealth can be supported by updating and unifying state licensure requirements that impede the ability of providers and health systems that operate in multiple states. Congress should grant HHS the authority to ease state licensure restrictions, allowing federal funding to incentivize agreements between states and permitting providers to practice to the top of their license.
- Closing the digital divide: unequal access to care is perpetuated by inconsistent and poor access to high-speed broadband internet. Congress can take action to expand broadband access as well as permanently allow access to telehealth through audio-only/telephone encounters. A national undertaking, similar to the Rural Electrification Act of 1934 that provided electricity to every home in America, is needed to close the digital divide.
- Safeguarding patient health data: consumers must be able to access telehealth services knowing their patient data is secure and protected. It is critical that health privacy and data security regulations be updated, not merely offered patchwork temporary solutions. Policymakers should create a new health data privacy regulatory program that would apply to health data regardless of how it is being used, or where it is being stored, maintained, reviewed or sent.
These current challenges must be addressed in order to ensure the long-term utilization of telehealth that benefits both the health care system and patients everywhere. Telehealth will be essential to getting us through this pandemic and imperative to a future health care system that can deliver high quality care where patients are, when they need it.