inhealth
institute for continuous health transformation
Joaquim Cardoso MSc
Founder, CEO and Senior Advisor
January 22, 2023
KEY MESSAGE(S)
- The use of telehealth soared during the pandemic and demonstrated its value in improving the delivery of and access to health care.
- But that increase in usage was made possible by the relaxation of federal and state waivers.
- To capitalize on what was learned during the pandemic, federal and state legislators should revamp regulations.
- Five priorities should guide their actions.
EXECUTIVE SUMMARY
There as a positive impact of telehealth during the Covid-19 pandemic, and there is the need for federal and state governments to recognize the value of telehealth and use what was learned to improve regulations.
- The authors propose five priorities for crafting new regulations, including expanding reimbursement for telehealth services, allowing for flexibility in the use of technology, and aligning regulations across state lines.
- Retaining and expanding the benefits of telehealth is important, as both physicians and patients have expressed support for the use of telehealth services.
There is a need for action to permanently implement the benefits of telehealth that were seen during the Covid-19 pandemic, as the federal legislation currently in place is temporary and set to expire at the end of 2024.
In the US, each state has its own policies on:
- 1.Which telehealth modalities are acceptable
- 2.Which medical professions are permitted to provide telehealth services and under what circumstances
- 3.How new patient-provider relationships are established.
- 4.Whether and how medications can be prescribed
- 5.Whether out-of-state practitioners may treat patients without holding a full in-state license.
- 6.How non-federal insurers reimburse telehealth.
To consolidate and build on the gains we saw in telehealth during the pandemic, the ATA supports the following five priorities as guides for the crafting of new regulations:
- 1. Interstate Care
- 2. Neutrality
- 3. Value-Based Payment
- 4. Underserved Communities
- 5. Remote Monitoring
EXCERPT OF RECOMMENDATIONS:
It’s Time to Cement Telehealth’s Place in U.S. Health Care
Harvard Business Review
by John Glaser, Kyle Zebley
January 20, 2023
The Need for Action
Unfortunately, the federal legislation easing the regulation of telehealth is temporary in nature: Again, its provisions will disappear at the end of 2024.
To consolidate and build on the gains we saw in telehealth during the pandemic, the ATA supports the following five priorities as guides for the crafting of new regulations:
- 1. Interstate Care
- 2. Neutrality
- 3. Value-Based Payment
- 4. Underserved Communities
- 5. Remote Monitoring
1. Interstate Care
Licensing barriers that keep providers from working across state lines or nationally should be removed.
As licensure will continue to be regulated by state governments for the foreseeable future, the best way to obtain access to care across state lines is to create easier pathways for out-of-state practitioners to treat patients across state lines via telehealth, including licensure compacts between states that enable a provider with a license in one state to practice in another state.
While we recognize that state legislatures and medical boards want to retain oversight and disciplinary authority over providers operating in their state, we support licensure flexibility models that provide accountability and also leverage telehealth to address workforce shortages and expand patients’ access to care.
State control of practice standards also responds to the often-unstated desire to tamp down competition:
In this case, a state legislature or regulatory body may seek to protect in-state brick-and-mortar providers by keeping out-of-state telehealth providers from offering alternatives to their patients.
This goal of keeping out-of-state telehealth providers out is often done through clinically unnecessary policy proposals such as mandating in-person or brick-and-mortar health care delivery, which limits the full potential of telehealth.
We think states can better serve their existing provider communities by taking steps to facilitate the incorporation of telehealth into routine care delivery rather than unnecessarily restricting telehealth use or making use cumbersome.
We discussed some of these steps earlier.
2. Neutrality
Access to telehealth shouldn’t depend on patients’ physical location, their access to a specific type of technology, or the quality of their communications infrastructure.
State and federal laws should ensure that telehealth is not held to a higher standard than in-person care and (as is true for the vast majority of care delivery) the standards of care should be defined by medical professionals and not spelled out in regulation.
For instance, Medicare significantly expanded access to clinically appropriate care during the pandemic by waiving geographic and “originating site” restrictions long embedded in law.
For the first time, Medicare beneficiaries could “go to the doctor” via telehealth without leaving their house. Medicare should make this option permanent.
Likewise, to improve patients’ access to necessary medications, the PHE waiver of the requirement that a patient meet with a provider in-person before that provider could prescribe controlled substances should be made permanent, and states should adhere to this standard as well.
3. Value-Based Payment
We won’t truly reap the cost-saving and quality benefits of telehealth until the payment structure rewards the effectiveness of care rather than the quantity delivered.
Value-based reimbursement would reward the use of technologies such as telehealth that enable advances in care quality, efficiency, and accessibility, and potentially reduce the overall cost of care.
There is no incentive to try to reap these rewards when the payment system is based on the volume of care delivered.
While there has been some momentum towards value-based payment, it represents a highly disruptive change, and regulators and payers have been understandably cautious.
However, too much of the current payment structure remains based on fees linked to the volume of services delivered.
Realizing that health care will live in a volume-based and a value-based payment world simultaneously for several years, Medicare should use its vast influence to embed telehealth in its volume-based physician fee schedule, which dictates what services are covered and how much providers will be paid.
In addition, Medicare should continue its efforts to introduce value-based care payment approaches. Commercial insurers should follow Medicare’s lead, and/or pursue their own telehealth-friendly payment innovations.
4. Underserved Communities
A looming provider shortage will disproportionately affect communities that are already underserved, whether because of remote location or because of poverty and high levels of Medicaid or unreimbursed care.
Telehealth can help bring routine care and screening to those communities, averting health problems and identifying those that need treatment before they become urgent.
Even if they are not quite ready to make telehealth benefits universal, all payers, public and private, should cover and reimburse for telehealth services specifically for these communities.
This goal can be achieved at the federal level if Congress enacts legislation to permanently adopt pandemic-era flexibilities for Medicare, Federally Qualified Health Centers, and Rural Health Clinics.
State legislatures must also work to expand coverage of telehealth services for their state Medicaid beneficiaries.
5. Remote Monitoring
The overall aging of American society presented access challenges even before the pandemic. Managing chronic diseases is costly, and not managing them is even more costly.
Leveraging telehealth for remote monitoring of chronic conditions such as diabetes and congestive heart failure can keep patients healthier, let them stay in their homes longer, and ensure they receive timely and clinically appropriate care without unnecessary travel.
Medicare can, if it chooses, use its existing authority to expand coverage for remote patient monitoring technology and other telehealth-based devices, assuming they prove their cost-effectiveness.
The federal and state midterm elections are behind us, and governments are gearing up to address their legislative and regulatory agendas for the year ahead.
The five priorities we have described should be on them. We believe that the United States can build on the progress it made during the pandemic, and protect the quality, safety, accessibility, and efficiency of health care while ensuring that the benefits of telehealth are available to everyone.
Originally published at https://hbr.org on January 20, 2023.
