Expanding access to telehealth is a 'hundreds-of-billion-dollar question'

It’s no surprise, at this point, that interest in telehealth has shot up in response to the COVID-19 pandemic. 

During the public health crisis, the federal government has enacted dozens of short-term policies making telehealth easier to access – recently supplemented by President Donald Trump’s executive order earlier this month. 

But telehealth’s future is still an open question – one that expert panelists at the Office of the National Coordinator for Health IT’s Tech Forum sought to answer, at least in part, on Tuesday.

“Not surprisingly, reimbursement has always been the number-one impediment to telehealth,” said Federal Office of Rural Health Senior Adviser for Telehealth William England during the discussion. Many payers have historically viewed virtual care as a cheaper option, meaning that providers who depend on reimbursement have been less inclined to offer it.

“Somewhat surprisingly, bandwidth has not been an issue” until relatively recently, said England. “However, now that [providers] are authorized under emergency legislation to reach directly to patients at their home, bandwidth is a big issue and we’re beginning to focus on that and discussing that with the FCC.”

“Reaching patients in their home – if they don’t have good self-coverage, broadband or bandwidth, telehealth is a significant challenge,” said England.

Particularly where underserved communities are concerned, said American Telemedicine Association President Dr. Joseph Kvedar, “We would advocate making bandwidth a utility in the same way that roads are and other public utilities exist: Everyone should be able to access high-bandwidth internet.”

At the same time, said England, such a project would take significant funding. 

“It truly is a … hundreds-of-billion-dollar question to implement broadband in full in all rural areas. We simply don’t have the ability to address that” as a country, he said. This is to say nothing, too, of the urban areas where individuals do not have internet access. 

“The focus needs to be, ‘Where are the most critical locations?’ There’s lots of discussion going on right now between the states and the FCC,” he continued. 

Additionally, England pointed out, virtual care software often presumes that users have high-speed internet available.

“Many of the apps that we’re running assume excellent broadband … And it may be that we need to think about how we’re writing our software and what kind of bandwidth it needs,” he said. 

Kvedar also points to reimbursement for audio-only visits as a way to address the issue of telehealth for groups currently being left behind. 

“It for us is a simple way to cross the digital divide,” he said. “There are lots and lots of examples of audio-only, and we should continue to support it.”

Despite the shortcomings, panelists said, telemedicine has acted as a way to reach patients who had been unable to get medical care – including before social distancing measures made it imperative to try and reduce in-person contact.

“If you have a lot of social determinants of health constricting your ability to get to a federally qualified health center, or you have childcare needs that prevent you from being able to leave the home,” telemedicine can be an ideal option, said Lisa McLaughlin, cofounder and co-CEO of Workit Health, an addiction care company.

“There are legacy regulations that we have that restrict patients from using the technology in ways that work for them and their bodies and living situations,” she said, specifically pointing to the originating site rule preventing doctors from being reimbursed for virtual care delivered at a patient’s home. 

“We’ve known for a long time it’s very [shameful] in many aspects of our society to receive addiction care. There’s still a lot of ‘not in my backyard’ ethos, a lot of stigma associated with mental healthcare acquisition,” McLaughlin continued. “In the context of digital care, that goes away.”

As far as future innovations are concerned, said Maryam Gholani, chief product officer at Providence Health, “There are tons [of things] that can be done … in every aspect of remote patient monitoring.”

But questions remain, she said: “How do we bring smart devices into the picture? Who’s going to pay for them? How are the patients going to set it up? If you think about the more senior patients, setting it up or troubleshooting the device, how is it going to work?” 

“Those are the challenges that we are looking at,” she said.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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