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Telehealth After the Pandemic: Overcoming Barriers

Dr. Joseph Kvedar

President, American Telemedicine Association

The COVID-19 pandemic has shaken up many aspects of life, and healthcare is no exception. 

These days, many patients can receive treatment from the comfort of their own homes, thanks to the growth of telehealth.

According to a report published by the Centers for Disease Control and Prevention, telehealth visits in March 2020, when the pandemic began in the United States, were up by 154 percent compared to one year prior. Furthermore, 2020 survey data from Rock Health found that rates of adoption of digital health tools, including live video telemedicine, grew by 10 percentage points from 2019 to 2020. 

During the pandemic, reimbursement, technology/privacy, and licensure are three facets of telehealth that have been relaxed, said Dr. Joseph Kvedar, president of the American Telemedicine Association. What will these areas, which allow patients to receive and financially cover care, look like in the months and years to come?

Kvedar said healthcare professionals and legislators have yet to determine all the answers, but he offered some speculation.

Reimbursement for telehealth 

First, reimbursement for telehealth visits looks positive, he explained. “Just about everyone, including Medicare, seems to coalesce around the notion that telebehavioral health is a good thing for the population at large — it’s dense access, it’s high quality,” Kvedar said. However, he argued that a Medicare statute, titled 1834(m), needs to change to allow for equal access to telehealth. Under this statute, providers can’t bill Medicare for a patient using telehealth unless the patient is in what’s called “a health professional shortage area, which is a narrowly defined geographic slice of America,” Kvedar. He added that the physician supplying the care must also be in a clinical setting, and then the patient must go to a physical clinic to receive further healthcare. 

“It’s a very ‘1990s’ view of the world, and that’s when that law was passed,” Kvedar said.

A hybrid approach to healthcare

As far as technology and privacy go, he explained that during the pandemic, the government announced it wouldn’t prosecute healthcare providers for using platforms like FaceTime and Zoom to connect with their patients. Now, the industry has developed HIPPA-compliant platforms to carry out telehealth visits to ensure patient privacy, and it is in what Kvedar calls a “two-channel system or hybrid environment.” In this stage, many doctors’ offices have reopened but telehealth visits remain available.

This approach may warrant new training or software to ensure patients are scheduled for the appropriate type of appointment: one in-person for those that need to be, or one digitally, if that approach is doable. If not, the patient and provider may find their time wasted, and in some cases, the patient may be billed twice, Kvedar said. This can present complications for doctors, patients, and Medicare alike.

“We need to develop a list of appropriate use cases for telehealth, maybe by each specialist or each practice … so that when people come into our practice, they’re not just randomly getting shunted around between these different care modalities,” he explained.

Cross-state healthcare

“The hardest one is licensure,” said Kvedar, who noted that each state has its own medical board with its own policy. “I think right now, 49 out of 50 States have loosened to their licensure requirements so that a doctor can practice across state lines with telehealth. It’s just not at all clear how that’s going to be after [public health emergency declaration],” he said. 

Barriers to equal access

Last, how accessible telehealth will be to all people in the United States is unclear.For example, some people may only be able to visit with their doctor using audio, not audio and video, due to poor access to digital tools. “We’re pushing very hard to make sure that gets somehow covered, and right now that’s a bit of an uphill climb,” Kvedar said.

“Another priority is that right now, there are many other types of healthcare providers that can bill Medicare for services that can’t bill for telehealth services, so we’d like to see that scope of providers that can do that,” he added.

Yet one more area that needs improvement is the telehealth equipment provided at federally qualified health centers. “Right now, they’re limited,” Kvedar said, “and we feel like that’s also important with respect to disparities and underserved populations.”

Although telehealth has introduced new challenges to the healthcare system, public opinion to this transition of receiving care digitally has been generally positive. “And why not?” Kvedar said. “It’s care delivered to your home.”

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