Long-Term Telehealth Policies are Required to Continue Improving Healthcare Access, Affordability and Equity

The following is a guest article by Stephanie Jamison, Director of Regulatory Affairs at Greenway Health, a leading health information technology services provider.

Temporary relaxation of certain telehealth regulations put in place during the COVID-19 public health emergency (PHE) was a necessary step to enabling care continuation between providers and their patients during shelter-in-place orders. Providers and practices that were previously unable to administer telehealth services were able to adopt such solutions in order to further transform care, improve outcomes, and to allow providers to more effectively and proactively connect with their patients.

In 2018, only 2% of commercially insured people had a telehealth visit with a provider, with a rate that was even lower for Medicare and Medicaid patients. While that number grew to about 14% the next year, it skyrocketed during the height of the pandemic to between 57% and 77% of all patients. Furthermore, before COVID-19, Forrester Research projected only 36 million telehealth visits for 2020, but quickly revised its forecast in April 2020, predicting virtual care would count for more than 1 billion visits. This dramatic jump showed that patients appreciated the convenience of care from the safety of their home, and the ability to communicate with their physicians more regularly and easily through a variety of channels, including video calls, email, text, patient portals and remotely connected devices.

The slow adoption of telehealth prior to 2020 resulted from a confluence of factors – from technophobia and resistance to change, to a reimbursement methodology that did not value the investments providers put into telehealth services or the positive impact offered to patients. However, change was thrust upon the healthcare community when it became clear that life was going to change quickly and drastically early in the pandemic. HHS acted quickly to sign the PHE, and providers reacted quickly and eagerly. This is reflected in the Centers for Disease Control and Prevention (CDC) data, which noted that more than 30% of healthcare visits from June to November 2020 took place via telehealth.

Similarly, providers – particularly those at federally qualified health centers (FQHCs) that cater to underserved populations – appreciated having additional channels to ensure patients received the care they needed, when they needed it. Physicians also liked the certainty of being reimbursed for delivering these vital services.

Making Relaxed, Temporary Telehealth Regulations More Permanent

Over the past year, telehealth has become engrained as an important component of the patient-provider relationship. But uncertainty about how long the temporary PHE rules would continue beyond the pandemic is putting these important virtual healthcare services at risk.

HHS renewed the PHE for COVID‑19 for another 90 days, extending it through April 20, 2021, and they have strongly signaled that they will continue to do so through the end of 2021. While this is welcome news, there is Congressional action needed to make some of the PHE provisions permanent.

While bipartisan bills have been proposed in Congress to encourage development of permanent rules governing telehealth offerings and reimbursement, no broad overhaul has been passed to give agencies direction on permanent rules, or to give providers and patients the reassurance that telehealth will remain a viable option in a post-pandemic world.

In the final 2021 Medicare Physician Fee Schedule, CMS made permanent nearly all the PHE expansion measures over which they have jurisdiction. They expanded the range of Medicare covered services and those who can provide those services and removed several barriers that were faced by non-physician clinicians. Now, providers can permanently furnish the following brief online assessment and management services, virtual check-ins, and remote evaluation services:

  • Licensed clinical social workers
  • Clinical psychologists
  • Physical therapists (PTs)
  • Occupational therapists (OTs)
  • Speech-language pathologists (SLPs)

The rest is up to Congress.

The Need to Act for FQHCs and RHCs

Telehealth is also viewed as an answer to greater challenges that FQHCs now face, as they manage a flood of new, underserved individuals who have lost their jobs, cannot afford insurance and have been pushed into Medicare or Medicaid because of the pandemic. For FQHCs, which are on the front lines of the pandemic, telehealth is one way they can ensure patients can access needed care despite significant challenges – such as transportation to and from doctor appointments, home, school and work pressures, as well as concerns about costs that can prevent them from regularly seeing their doctors in the office.

Many have noted that the increased use of telehealth during COVID-19 has resulted in high-quality outcomes for patients and has closed workforce gaps for providers. These benefits could continue well past the PHE with the right laws and regulatory frameworks in place. But many FQHCs, community clinics, hospitals and private practices fear they will not be able to continue offering telehealth services if the PHE flexibility disappears.

As lawmakers begin to take up this issue again, there are key provisions that would ensure providers can continue offering telehealth. For example, legislation should:

  • Remove arbitrary geographic restrictions on where a patient must be located in order to utilize telehealth services
  • Enable patients to continue to receive telehealth services in their homes
  • Ensure FQHCs and rural health centers can furnish telehealth services

Further, Congress must act this year to make sure FQHCs and RHCs are able to keep providing telehealth services to thousands of vulnerable Americans.

Before uncertainty rolls back the progress that has been made to expand telehealth usage and adoption, actions must be taken. Congress and regulators must fundamentally change the approach to accessing and paying for telehealth services. With more incentives, telehealth can support for acute, post-acute, long-term and chronic care, often at lower costs than traditional reimbursements, and permanently align care with the most appropriate and cost-effective settings for each patient. Most importantly, perhaps, those actions could be the cure to what ails our healthcare system today, by providing more equitable and affordable access to quality care.

About Stephanie Jamison

Stephanie has fifteen years of experience in healthcare and health IT public policy. She serves as Greenway Health’s Regulatory Affairs Director, a position she has held since January 2019. In this role, she also represents Greenway on the Electronic Health Record Association (EHRA) as a member of the Executive Committee, which serves as the collective leadership voice for the Association. Prior to joining Greenway, she held various public policy and regulatory affairs roles with WellCare Health Plans, HIMSS, the National Governors Association, among others.

   

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