June 12, 2020
Maverick Health Policy Update
Only What Matters On Health Information Policy
Just like the animated family-from-the-future sitcom The Jetsons, we may never go to the doctor’s office again. Everyone seems to agree that the acceleration of telehealth services will continue beyond the pandemic like everyone says it will. Maverick Health Policy explores the latest news in this space.
CMS Administrator Seema Verma said “it would not be a good thing to force our beneficiaries to go back to in-person visits.” Influential groups like the American College of Physicians and Premier are calling for many of the telehealth COVID-19 waivers to remain permanent. Even the powerful U.S. Senate HELP Committee Chairman Lamar Alexander included telehealth in his 40-page white paper to prepare for the next pandemic: “RECOMMENDATION 4.2: Ensure that the United States does not lose the gains made in telehealth.”
The FCC gave out another $20+ million in support of specific telehealth needs (e.g., UPMC Children’s Hospital of Pittsburgh got funds to remotely monitor immunocompromised kids who received organ transplants), for a total of $100M in funding for provider telehealth projects since the pandemic began.
The VA is expanding telehealth for precision medicine and genetic counseling to veterans with cancer, and the NCQA updated its HEDIS telehealth quality measures.
One Thoughtful Paragraph
Like everything except love and cloud-watching, getting telehealth beyond a great idea is about the money. Maverick Health Policy is confident that all of the traditional barriers (e.g., licensure, technology, originating site rules, cultural norms) to telehealth expansion can be overcome -- but the real problem is reimbursement. If there is no financial incentive to switch some services from in-person visits -- traditionally paid at a higher rate -- to lower-cost video, phone, and remote monitoring services -- telehealth’s expansion isn’t here to stay. So what will it take? First, investors have to believe that telehealth is here to stay to grow the market -- and apparently they do, evidenced by the latest funding rounds here, here. Second, doctors have to be for it -- which means they have to be able to make a living from telehealth services and medical students must be trained on these platforms. Some doctors want the same rate of pay for telehealth visits as in-person. But maybe the payment model needs to change, and the discussion around value-based care is earnest, often, and COVID-19 is forcing us to really re-think our health care delivery system. Finally, with uneven state-level telehealth reimbursement laws, the federal government is going to have step in beyond just helpful hints in a Medicaid telehealth toolkit. Some say the answer is parity, and there is no lack of congressional proposals: here, here, here. We have been having this change-the-model-for-telehealth-payment discussion for a long time, so here is hoping we can figure out how to make the money flow in the right direction.