Despite increased use during the pandemic, many states either already have or plan to roll back expanded telehealth benefits—leaving many patients feeling "left behind to get worse," Stephanie Armour and Robbie Whelan report for the Wall Street Journal.
During the early months of the Covid-19 pandemic, many doctors and patients transitioned to telemedicine, in part due to state emergency orders that mandated the coverage of telehealth visits and waived requirements for out-of-state medical licenses.
According to Alliance for Connected Care (ACC), a nonprofit focused on health care technology and regulation, all 50 states and the District of Columbia implemented emergency declarations to waive certain licensing requirements for out-of-state doctors conducting telehealth appointments.
At the same time, many commercial insurers and government payers expanded telehealth coverage, with many for the first time offering to pay or reimburse for virtual visits at the same rate they did in-person visits.
As a result, telemedicine use surged, especially among populations vulnerable to the coronavirus, including older adults and those with ongoing medical conditions. For instance, telehealth visits were 154% higher during the last week of March 2020 than the same time period a year earlier, according to CDC data.
"It was like someone switched on a light," said Geoffrey Boyce, CEO of Array Behavioral Care, a telehealth provider that specializes in mental-health counseling.
But despite this increased use of telehealth, many state emergency orders have already expired—and several insurers have also rolled back expanded telehealth provisions. According to AAC, 25 states have already ended the emergency declarations that were in place earlier in the pandemic.
Some licensing boards oppose a permanent extension of pandemic-era telehealth allowances, citing potential for increased fraudulent activity. But many hospitals, doctors, patient advocates, and telehealth providers say they believe this permanent extension would increase access to care, Armour and Whelan report.
With access to telehealth services at risk, many have expressed concern for patients who depend on the flexibility and expanded care options associated with telemedicine.
For example, Jennifer Roman, a 27-year-old with multiple conditions who has had 10 brain surgeries over the past six years, lives in New Jersey and sees specialists at both Johns Hopkins University and New York University. She takes medications that her doctors have monitored via videoconference throughout the pandemic.
But in June, Roman's insurer informed her that her out-of-state telehealth visits would no longer be covered. As a result, she would need to make a two-hour drive to see each of her doctors in person—a trip that would be too difficult for her to make regularly because of her health conditions. Additionally, because of the rarity of her conditions, there weren't closer specialists in her home state.
Since then, Roman has been skipping the appointments that she was able to conduct virtually last year, the Journal reports. "For people in the rare-disease community, what's happened as a result of telehealth coverage being cut back is, we have been left behind to get worse," Roman said.
These treatment disruptions have also occurred among mental health patients. A telepsychiatry startup called MindStrong was forced to close for two weeks in July after Georgia's emergency declaration expired, the Journal reports.
According to Kara Ditto, a psychiatrist in Virginia who sees over 200 MindStrong patients, this disruption was the hardest for patients on medication who were being monitored by physicians.
"These are people who for medical and economic reasons just can't drive or be driven two hours to see a mental-health specialist," Ditto said. The practice later reopened. (Armour/Whelan, Wall Street Journal, 11/22)
By John League, Managing Director
Time's run out—we are experiencing telehealth rollbacks and, as this news story highlights, it is harming patients and their care. We have been talking about this for a long time, and the main call to action is still relevant: Organizations who recognize benefits to patients from the use of telehealth should take an active role regarding the expiration of pandemic flexibilities.
Not every stopgap measured is worth preserving, but it shouldn't be all or none. Consider how beneficial it was to have flexible telehealth measures throughout these early stages of the pandemic. It is surprising that stronger efforts are not underway to advocate for patients’ continued access to telehealth. Every health care leader should advocate for patients' continued access to telehealth services. So what do stronger efforts actually look like?
Siloed approaches to telehealth lead to tension, fragmentation, and redundancy. Stakeholders must recognize their shared goals among and work to join forces for larger success. Clinicians, health systems, health plans, and technology vendors are all critical to the role of telehealth. No one needs a “telehealth strategy,” but everyone needs to understand how telehealth can help their organization meet its existing strategy.
Barriers are likely to be structural, which means that no individual stakeholder can solve them on their own. Among the barriers of reimbursement, data, culture, digital literacy, and more, there is one that is crucial now—regulation. State and federal regulations were already limiting, variable, and confusing prior to the pandemic. That patchwork of regulation has not consolidated toward a single coherent vision despite the hard-earned lessons of the past two years.
Overcoming these barriers requires multiple stakeholder groups converging to build a shared infrastructure in which telehealth can operate effectively. This includes a shared structure for data capture and exchange, a shared regulatory structure to ensure equitable access, and a shared reimbursement structure to incentivize appropriate use. This will require compromise and tradeoffs—no one is going to get everything they want. The biggest risk is that if no one agrees to give up anything, no one will get anything from telehealth.
Telehealth needs to become systemically integrated into care delivery. We are at an inflection point with widely changing regulations, so it makes sense why leaders may be thinking primarily about legislation, regulation, and funding. But don’t forget about the broader set of activities that influence when and how telehealth happens. Activities such as guiding patients to telehealth, clinical research and guidelines, data aggregation, advocacy, and tech innovation all play a role here, and there is a real chance for cross-industry collaboration to solidify the building blocks of the infrastructure required to optimize telehealth.
Every organization functions differently and has different goals for telehealth. Determining what role your organization is best positioned to play requires considering a broad range of advantages and disadvantages, which include things like funding, data, influence, bandwidth, expertise, relationships, buying power, non-monetary assets, or other capabilities. Our industry must work together to fill in the gaps. For example, some organizations may be well-positioned to advocate for legislation that supports broadband access, others may be better positioned to support digital literacy campaigns.
Ultimately, the success of telehealth programs often depends on the reimbursement and regulatory environments in which they operate. Federal and state policies govern how virtual care can be delivered and reimbursed, and overly restrictive regulations can substantially reduce the feasibility and impact of telehealth services—exactly what we saw prior to the pandemic and what we are seeing now with rollbacks. By advocating for more supportive legislation, provider organizations can actively shape telehealth policy development in their favor. For help with how to change the policy landscape in your state, check out our advocacy toolkit that includes step-by-step guidance on identifying policy targets, building an advocacy network, and working with local legislators.
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