HIMSS Digital experts: Providers may once again face a ‘labyrinth’ of telehealth policies  

A woman walks through a maze

A woman walks through a maze

Industry groups have recently raised the alarm about a so-called “telehealth cliff.” But after more than a year of life during a pandemic, could virtual visits fade away so quickly?

After the events of 2020, it’s difficult to imagine virtual visits disappearing, even as 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’s going to be one of my major concerns, that there will be reimbursement, but it will become so difficult to navigate that labyrinth of payment policies,” said Ateev Mehrotra, an associate professor of healthcare policy at Harvard Medical School.

For example, he was recently talking to a provider who offers telemedicine-based treatment for opioid use disorder. For now, the public health emergency has standardized many of the regulations that come with virtual and substance use treatment. But that could quickly become complicated, with differing rules about reimbursement, physician licensure, and prescribing from state to state.

“I think by and large we’ve won the permissibility battle,” added Dr. Peter Antall, Amwell’s chief medical officer. ”Where I think we’ve been stuck for a number of years is on reimbursement. It’s not that no payers are reimbursing, it’s that it’s not consistent.”

Questions about whether telehealth increases fraud risks and whether it is cost efficient have hampered sweeping industry change. One concern is that virtual visits might be too convenient, increasing healthcare spending, though this isn’t always a bad thing, Mehrotra said.

As legislative action moves slowly, the Centers for Medicare and Medicaid Services has at least kicked the can down the road for many of the temporary provisions. In its proposed physician fee schedule for 2022, the agency proposed continuing most of the current telehealth provisions through the end of 2023, while more permanently expanding its coverage of tele-mental health.

But one of the biggest policy decisions actually rests with Congress. Current telehealth site restrictions, which limit Medicare from covering telehealth unless patients live in a rural location and have the visit take place at a healthcare facility, are encoded in the Social Security Act and can only be changed by legislators.

While removing these restrictions has garnered bipartisan support, it simply hasn’t happened yet.

Finding the best setting for patients
For some people, the sudden switch in telehealth regulations during the pandemic was life changing. For Stacy Hurt, a survivor of stage IV colorectal cancer who is also caring for a son with a rare disorder, she finally got what she had been asking doctors for after 15 years.

“Reaching (my son’s) diagnosis, we saw 60 different specialists. It was always the same thing. It was be seen, order a test, come back and be re-seen,” she said. “He’s non ambulatory, so we have to lift him off the floor into his wheelchair, into the accessible van, come out again and take him in. And the whole time, he’s immuno-suppressed… I was asking that whole time, ‘can we do this via computer?’ and I was told no, no, no.”

Being able to do some of their appointments virtually “eases our minds a lot,” she added.

Hurt, a patient consultant who worked in healthcare for 20 years, sees a necessity in cross-state licensing for telehealth, which could potentially save cancer patients who are not near an NCI cancer center and might otherwise have to travel across the country to get a second opinion.

Access to reliable broadband is also critical, and some funding was set aside for this purpose in the Covid-19 relief package that was passed earlier this year.

“Universal access to broadband is a real problem. I can tell you specifically about patients that go to coffee shops and libraries for wifi to talk about their health issues,” Hurt said.

People might also face challenges with telehealth if their home isn’t a safe place.

Ultimately, for telehealth to succeed in the long-term, Hurt said providers must communicate to patients about their options, and even more importantly, listen.

“Listen to your patients and make sure they have what they need to ensure a high quality virtual visit,” she said.

 Photo credit: syolacan, Getty Images

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