Will telehealth face hurdles in access, coverage in a post-pandemic world?
Telehealth’s rise to a regular modality of care coincided with the COVID-19 public health emergency. But whither telehealth in the post-pandemic world?
In March, some clarity arrived, at least in the short term. Congress passed the $1.5 trillion omnibus spending package, which included, among other things, $1 billion for the Advanced Research Projects Agency for Health that President Joe Biden proposed to hasten biomedical and health research, as well as a 5-month extension of telehealth flexibilities that had been allowed under the COVID-19 emergency.
The legislation allows for continued Medicare coverage of telehealth visits, all Medicare-enrolled providers to continue to bill for telehealth services, and coverage of telehealth visits in a patient’s home or medical facilities, among other provisions.
“This language keeps the flexibilities in place for all of this calendar year, which is big,” Kyle Zebley, vice president of public policy at American Telemedicine Association (ATA) and executive director of ATA Action, told Healio. "The assumption is that the public health emergency could end right in July, and then is the 151-day window that will get us through at least December, post-election, which would allow Congress to act on it again before the year is out."
But how will telehealth be handled by providers and insurers in the long-term? What questions remain unanswered and what concerns do oncologists have moving forward?
“There is uncertainty in the path ahead,” Debra Patt, MD, PhD, MBA, FASCO, executive vice president of Texas Oncology, told Healio. “I worry about two things. One, federal policy sets the stage, but state policy also governs telemedicine and that can be variable among states. I think the state policies need to support telemedicine in alignment with federal policy.”
Patt’s second concern is how insurers beyond Medicare manage telehealth visits in the post-COVID world.
“Will private insurance companies continue to follow suit? I would say, by and large, so far, they have. They also continue to see it as a useful tool for patients to get the care that they need,” Patt said. “They have followed suit, with some caveats: some stopped paying for phone-only services and require the bimodal, audio and video services. Those are the details that remain uncertain and provide some degree of risk for practices and doctors who continue to want to use telemedicine as a useful tool to serve patients. But it’s my perception that that risk is low overall.”
Within the last 2 years, patients, providers and policymakers have all recognized the usefulness of telemedicine. But just as different industries continue to use programs such as Zoom for remote communication despite also having the ability to meet in person, patients and providers alike see the advantages telehealth provides in a post-pandemic climate.
Like Patt, Zebley sees people from all sectors of the health care community moving in the same “positive direction.” But he said he also didn’t want to come off as “too pollyannish,” referencing the people who “really benefited from the way the U.S. health care system was structured” prior to the pandemic.
“There are also those who, whether they say it directly or not, view patients as a market share,” Zebley said. “And they want to maintain access to patients and do not want telehealth companies or those organizations that are offering telehealth services to interfere with and disrupt their market share. While everyone is going to have to start off saying that they’re supportive of telehealth in any public remarks — because you’re not treated seriously if you’re not supportive of telehealth — they could be very savvy in putting up obstacles, which come in a variety of different ways — some more creative than others.”
Advanced Research Projects Agency for Health (ARPA-H). www.nih.gov/arpa-h. Accessed April 28, 2022.
ATA and ATA Action commend Congress for extending telehealth flexibilities post public health emergency to temporarily avoid the 'telehealth cliff' but will continue to work with Congress on permanent solutions (press release). www.americantelemed.org/press-releases/ata-and-ata-action-commend-congress-for-extending-telehealth-flexibilities-post-public-health-emergency-to-temporarily-avoid-the-telehealth-cliff-but-will-continue-to-work-with-cong/. Published March 9, 2022. Accessed April 28, 2022.
For more information:
Debra Patt, MD, PhD, MBA, FASCO, can be reached at Texas Oncology, 204 Balcones Drive, Austin, TX 78731; email: firstname.lastname@example.org.
Kyle Zebley can be reached at email@example.com.