October 09, 2020 – The eHealth Initiative has unveiled recommendations for federal policy changes to help expand telehealth access and coverage during and beyond the coronavirus pandemic.
The 22-page report comes roughly a month after a similar report issued by the Taskforce on Telehealth Policy, a group spearheaded by the American Telemedicine Association, Alliance for Connected Care and National Committee for Quality Assurance. Together, the studies put pressure on Congress and federal agencies like the Centers for Medicare & Medicaid Services to expand the playing field for providers by making it easier and more profitable to use telehealth.
The eHI report was developed by the organization’s COVID-19 Federal Policy Work Group, comprised of eHI staff and representatives from the American Academy of Family Physicians, American Heart Association, the Marshfield Clinic, Change Healthcare, NextGen Healthcare, Cerner and others.
“Policymakers have a unique opportunity to learn from this experience and the impact of a once-in-a-century global pandemic and should not wait until we are faced with the next crisis to implement new policies that will strengthen and modernize our health care system,” the report concludes. “We encourage Congress and the administration to meet this opportunity and heed the recommendations of the Work Group.”
The report focuses on five broad areas: Telehealth, broadband connectivity, artificial intelligence and machine learning, health information exchange and interoperability, and public health surveillance.
Regarding telehealth, the report calls on Congress to remove limits on where the patient can be to receive telehealth services, give the Health and Human Services Secretary the authority to expand the list of healthcare providers able to use telehealth, expand access to telehealth for federally qualified health centers (FQHCs) and Rural Health Clinics (RHCs), and give HHS and CMS the authority to waive telehealth restrictions during future national emergencies.
The report also urges policymakers to support licensure portability through a compact that enables care providers licensed in one compact state to practice in any other compact state – much like the Nurse Licensure Compact (NLC). It notes the Interstate Medical Licensure Compact (IMLC), which is in effect in 29 states and Washington DC and has cost the HRSA some $7 million, focuses on expedited licensure, which still forces physicians to get a license in each state.
“Policymakers should ensure that all financial and policy incentives – including existing and new HRSA grants – encourage states to adopt a similar mutual recognition compact for physicians,” the report recommends. “This path forward recognizes the rights of states to regulate the practice of medicine within their borders, protects patients, and at the same time facilitates access to care across state lines.”
The eHI study also makes a pitch for remote patient monitoring, a fast-growing subset of connected health that pushes care out of the hospital and into the home. CMS first recognized RPM with some limited reimbursement opportunities in 2018, and has been careful to keep RPM guidelines separate from its more restrictive telehealth rules since then.
The report calls on CMS to expand opportunities in RPM for both acute and chronic care management, as well as allowing providers to obtain patient consent for those services once a year, rather than every time the service is used. It also calls on CMS to incentivize providers and patients to use platforms that reduce hospitalizations, and it asks the HHS Office of the Inspector General (OIG) to establish a permanent anti-kickback safe harbor statute that allows providers to reduce or waive cost-sharing for RPM technology.
The eHI report also tackles broadband connectivity, a significant barrier to telehealth adoption in rural and low-resource areas.
It urges Congress to add funding for the Federal Communications Commission’s COVID-19 Telehealth Program, which exhausted its $200 million budget in July, but refine eligibility requirements “to hospitals and health systems that serve rural and underserved populations, regardless of non-profit or for-profit status.”
It also urges Congress to “make a sustained and meaningful investment in rural broadband infrastructure” by supporting the FCC’s Universal Service Fund (USF) programs.
“Building out broadband infrastructure in rural areas is extremely expensive, and there are few incentives for private investment given the lack of market for the product – there simply are not enough people in extremely rural areas to justify the expense of building broadband infrastructure,” the report concludes. “Congress must appropriate sufficient funds to build broadband infrastructure to the last mile and subsidize telecommunication companies’ service of those areas.”