For a while now I’ve been waiting for the government to do the telehealth studies that are needed to make telehealth reimbursement something that’s going to last long term. I’d heard from my telehealth policy friends in Washington that prior to the pandemic there were many in Washington that were afraid to reimburse telehealth visits because they weren’t sure of the implications of doing so. Would there be overuse? Would there be fraud? etc etc etc.
Thanks to the pandemic, we now should have all the data that’s needed to understand the real impact of doing telehealth. At least that’s what I think should be the case. Although, one thing I hadn’t remembered was that you can make statistics say anything you want to say. It’s going to take a concerted effort to make sure an analysis of telehealth usage is done properly.
A great example of this was in a recent Tweetstorm by Andrey Ostrovsky, MD who is the Former Chief Medical Officer at Medicaid. Check out the tweetstorm below where he breaks down a GAO study on telehealth:
1/ Report on #telehealth from GAO has reasonable methods but draws the wrong, negatively skewed conclusion toward telehealth reimbursement that compromises health equity. Below is an elaboration why…gao.gov/assets/gao-21-…
2/ First, the researchers methods are reasonable. They primarily rely on CMS reports, which have limited utility given lack of granularity of those data, especially around disparities. But the researchers did supplement with interviews with providers, consumers, state leaders.
3/ Report appropriately finds that Medicare telehealth waivers resulted in increased utilization of telehealth services & provided beneficiaries access to services that would not have otherwise been available during the early days of the #COVID19. That was the point of waivers.
4/ Report also found that #telehealth waivers played a critical role in maintaining access to services when beneficiaries and providers were concerned about the transmission of #COVID19.
5/ These findings reinforced by interviews with groups representing providers and beneficiaries confirming flexibilities enabled beneficiaries to continue accessing care.
6/ Then @USGAO starts to draw conclusions in a regressive, rigid way regarding digital access and f/w/a. First they invoke a study showing 26% Medicare benes lacking digital access to justify NOT covering telehealth to avoid perpetuating disparities…
7/ Latter conclusion completely misses mark; lack of digital access is for VIDEO, which is all the more reason to cover audio-only (with guardrails). Additionally, more justification for all of government approach to increase digital access NOT curtail telehealth reimbursement.
8/ Another flawed conclusion from @USGAO is their concern for f/w/a. f/w/a IS a concern but telehealth can be a mechanism to REDUCE not increase f/w/a if AI/ML is creatively applied to mine the digital exhaust of digital interventions to track and prevent f/w/a.
9/ Biggest miss of all is the failure to mention that the solution to sustainable, equitable achievement of the quadruple aim isn’t limiting telehealth, it’s accelerating value based payment. @USGAO you can do better.
Lots to chew on here, but the section on NOT covering telehealth because they wanted to avoid perpetuating disparities is telling. As Dr. Ostrovsky notes, it you just open it up to audio-only, that solves a lot of those issues. Plus, I’d add that not doing telehealth likely doesn’t do anything to resolve the disparity either. My guess is that many people who can’t do a video call probably have transportation issues as well and so the disparity still remains.
Plus, it doesn’t seem to acknowledge the benefit that telehealth provides so many patients who are dealing with major health challenges and telehealth is a much more convenient option. How about the disparity they feel being forced to come to the office when that’s a massive physical challenge to them?
Lots more to chew on here and this is likely just the beginning of the analysis of telehealth data. However, it’s a good illustration of how telehealth reimbursement could be in trouble if people don’t look at the data and situation appropriately. It’s good to have people like Dr. Ostrovsky doing what he can to call out bad interpretations.
You will ALWAYS have disparity in all markets!!! Telehealth is just another way to obtain care, and it has both benefits for Patients in Transportation and Convenience, and negatives in the inability to capture physical parameters as a part of H & P.
What the GAO is saying is much akin to stating that there is a disparity in provision of Antibiotics because only presumptively infected individuals receive them. The entire notion of “Disparity” is an exercise in ignorant logic in just the same way. This is an example of how we are not served when ideological factors enter into public policy. To this way, leads madness.
It would be great to have some research to determine the types of conditions for which different telemed modalities are effective, rather than just opening reimbursement for all. A telehealth visit only leading to an office visit is not adding a lot of value. Equity is important but quality, effective care and financial reimbursement are as well. Are proponents most interested in equity or financial gain?
I agree completely. I’d like to see this research as well. I think many organizations would love to have a framework for when telehealth is just as good or even better and when it’s not. Although, I think if we don’t figure out the reimbursement piece, then that framework won’t be nearly as useful.
Just an opinion about Telehealth. Telehealth is just a new revenue stream and is in addition to a office visit. It does not take the place of an in-office visit. A diagnosis cannot be made in telehealth, only a Q&A session with the patient. This used to be part of an office visit to catch up on any changes in the patient but is now being charged separately. Telehealth does not replace anything as any outcomes from the telehealth session must be addressed in-office. It just adds to cost and the bottom line of the provider. I find it interesting that a facility fee can be charged as part of the cost when there is no facility use. But then this is clinically driven revenue with almost no overhead.