Industry groups have recently raised the alarm on a so-called “telehealth cliff”. But after more than a year of life during a pandemic, could virtual tours disappear so quickly?
After the events of 2020, it is difficult to imagine the disappearance of virtual tours, even when more patients opt for in-person appointments. Rather, healthcare providers may face a maze of different policies between states and plans, experts said during a panel at HIMSS digital.
“That will be one of my biggest concerns, that there will be reimbursement, but it will be very difficult to navigate that maze of payment policies,” said Ateev Mehrotra, associate professor of health policy at Harvard Medical School.
For example, you were recently speaking with a provider who offers telemedicine-based treatment for opioid use disorder. By now, the public health emergency has standardized many of the regulations that come with virtual and substance use treatment. But that could quickly get complicated, with different rules on reimbursement, medical licensing, and prescribing from state to state.
“I think overall we have won the battle of permissibility,” added Dr. Peter Antall, Amwell’s chief medical officer. “I think we have been stuck for several years on repayment. It is not that any payer is repaying, it is that it is not consistent.”
Questions about whether telehealth increases fraud risks and whether it is profitable have stymied a sea change in the industry. One concern is that virtual tours can be too convenient, increasing spending on health care, although this is not always a bad thing, Mehrotra said.
As legislative action progresses slowly, the Centers for Medicare & Medicaid Services have at least kicked the way for many of the temporary provisions. In its proposed 2022 physician fee schedule, the agency proposed to continue with most current telehealth provisions until the end of 2023, while more permanently expanding its tele-mental health coverage.
But one of the most important political decisions rests with Congress. Current restrictions on telehealth sites, which limit Medicare to cover telehealth unless patients live in a rural location and visit is in a health care facility, are codified in the Social Security Act and only legislators can modify them.
While the removal of these restrictions has garnered support from both parties, it just hasn’t happened yet.
Finding the best environment for patients
For some people, the sudden change in telehealth regulations during the pandemic changed their lives. For Stacy Hurt, a stage IV colorectal cancer survivor who is also caring for a son with a rare disorder, she finally got what she had been asking for from doctors after 15 years.
“When we got to the diagnosis (of my son), we saw 60 different specialists. It was always the same. She saw herself, ordered a test, came back and was seen again, ”she said. “He can’t walk, so we have to pick him up off the ground to put him in his wheelchair, put him in the accessible van, get out again and take him inside. And all the time, he’s immunosuppressed … I’ve been asking the whole time, ‘can we do this through the computer? ‘and they said no, no, no. “
Being able to make some of his appointments virtually “makes us very reassuring,” he added.
Hurt, a patient consultant who worked in healthcare for 20 years, sees a need for interstate licensing for telehealth, which could save cancer patients not near an NCI cancer center. and that they may otherwise have to travel across the country to get a second opinion.
Access to reliable broadband is also critical, and some funds were set aside for this purpose in the Covid-19 aid package that was approved earlier this year.
“Universal access to broadband is a real problem. I can tell you specifically about patients who go to coffee shops and libraries looking for Wi-Fi to talk about their health problems, ”Hurt said.
People can also face challenges with telehealth if their home is not a safe place.
Ultimately, for telehealth to be successful in the long run, Hurt said providers must communicate their options to patients and, more importantly, listen.
“Listen to your patients and make sure they have what they need to ensure a high-quality virtual visit,” he said.
Photo credit: Syolacan, Getty Images