By Surabhi Dangi-Garimella, Ph.D.

Thank goodness for telehealth! If there is one thing that the COVID-19 pandemic made clear, it’s the fact that telehealth visits have been significantly underutilized by our health care system. Extensive use of telehealth services was restricted by payer policies, particularly Medicare. While the pandemic forced a sharp pivot in the way health care was delivered, especially in the early months of 2020, it was a temporary measure to ensure continued care delivery during a public health emergency. Medicare is now seeking comments on whether to make these changes permanent. 

Beyond access, telehealth often:

  • Addresses health disparities and reduces stigma
  • Saves time and money
  • Helps prevent spread of infectious diseases
  • Makes clinic visits easier for those with chronic conditions
  • Helps reinforce treatment adherence
  • Cuts down on no-shows

At the Cusp of Temporary vs Permanent

Telehealth was critical for patients to continue receiving their care during most of 2020, both due to hospital/clinic-imposed restrictions and also to keep themselves safe from potential exposure to the SARS-CoV-2 virus. However, traditional Medicare services prior to the pandemic were restricted to patients living in rural areas. Policies also dictated the site where the enrollees could get the service and which providers could be reimbursed for telehealth. These policies changed during the pandemic:

  • No geographic restrictions for patients or providers
  • CMS widened the list of eligible telehealth services
  • Providers could reduce or waive patient cost-sharing for telehealth services
  • Providers could lend services outside their state of enrollment
  • Audio-only services would also be covered

CMS is now contemplating next steps for this temporary expansion, which currently lasts through the end of 2021 but could be extended through December 31, 2023. Should all or certain policies be made permanent? While CMS received many requests to make some of the changes permanent for the 2022 calendar year, CMS deemed that the requests fell short of the criteria needed for permanent policy changes. The extension through 2023 provides additional opportunity for stakeholders to gain support for their requests.

Stakeholders Want the Telehealth Option, With Caveats

The American Hospital Association (AHA) is a big proponent of telehealth. In a recent statement, AHA stressed the broad increase in patient access to physicians, therapists, and other health care practitioners created by telehealth services, especially for patients living in rural areas or those who don’t have easy access to a health care system. The temporary telehealth flexibility by CMS had a huge positive impact, according to AHA:

  • Increased access to specialists: a hospital reported 10-fold increase in access to specialists and a 39% increase in new zip codes that were reached
  • Prevent unnecessary hospitalizations and ER visits
  • Reduction in missed appointments due to ease of access to a provider from home

During a recent webinar on the topic, Stacey Worth, Counsel, Aimed Alliance, pointed out that along with the upside, telehealth can have certain disadvantages, such as:

  • It does not allow patient examination
  • Provider may miss symptoms
  • You cannot conduct lab work via telehealth
  • There are potential security concerns such as with your personal heath data
  • There could be out-of-pocket costs due to coverage limitations
  • Patients could  have access issues if there is no broadband access or if they are technologically challenged

Variations in payer policies and differences in state laws add complications on the provider side. For example, some states limit the types of providers that can offer telehealth services. Federally Qualified Health Centers and rural health clinics are often excluded from coverage for telehealth services.

A survey among 2,589 U.S. adults—a majority of whom had at least one medical condition—conducted between June 29 and July 2, 2021, found that:

  • Since March 2020, 86% adults had received some form of telemedicine: 84% in-person, 38% telehealth, 19% audio-only
  • 82% thought telehealth is great during the public health emergency, but in-person visits are best
  • 80% said they will prefer in-person doctor’s visits to telehealth
  • 37% postponed their medical appointment until in-person visits were restored
  • 52% were concerned about missed diagnosis with telehealth
  • 62% were concerned that if they don’t see their physician in-person, they won’t receive the care they need
  • 78% thought something will be missed if they don’t have an in-person visit
  • 70% adults are open to telehealth appointments as long as they can see their doctor in-person once or twice a year

These findings emphasize the need for patient and physician input when developing telehealth policies, which should allow a mix of in-person and telehealth visits.

David Charles, MD, Founder, Alliance for Patient Access, agreed with the findings of the survey. “There should be flexibility in that the patient and the physician should decide the best way to conduct the appointment: in-person or via telehealth. This is a case-by-case decision,” he said.

Policy Changes Needed

Ms. Worth said that legislative changes will be needed and that lawmakers have sent a letter to HHS to permanently make changes to telehealth beyond the pandemic. Of the 40 bills that have been introduced, many include similar protections: interstate medical licensure compact, flexibility in originating sites, parity of coverage and reimbursement for in-person and telehealth visits, etc. Here are some of the bills:

 

Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.