The five strategies, laid out in a recent Health Affairs blog, target barriers to telehealth adoption that go beyond reimbursement issues.

 By Eric Wicklund

September 11, 2020 – While federal and state regulators are developing strategies to give telehealth room to grow after the coronavirus pandemic, a recent series of surveys among New York physicians suggests that growth must be tied to efforts beyond reimbursement changes.

The surveys, conducted by the New York City Department of Health and Mental Hygiene’s Bureau of Equitable Health Systems and researchers from the New York School of Global Public Health, identify five strategies beyond current policy to foster telehealth growth in primary care. They’re featured in a recent blog in Health Affairs.

According to the blog, healthcare access is typically defined by five qualities – affordability, availability, accommodation, accessibility and acceptability – yet current telehealth policies only address the first two, and that’s not enough to compel connected health integration in primary care beyond the COVID-19 crisis.

“Other policies … can optimize telehealth access and quality by promoting ‘accommodation,’ ‘accessibility,’ and ‘acceptability’ for telehealth, to complement increased reimbursements,” the blog concludes. “Failing to address these barriers – which affect the least resourced primary care practices that are primarily serving the most vulnerable patients – will only serve to widen patient-level disparities in access to quality telehealth care. These gaps offer actionable opportunities for public and private insurers and policy makers to intervene and improve the integration of telehealth into primary care.”

Culled from a series of surveys taken between April and July, the responses support “timely regulatory changes in facilitating telehealth adoption,” including recent efforts by the Centers for Medicare & Medicaid Services to expand telehealth coverage in its proposed 2021 Physician Fee Schedule and President Trump’s Executive Order to improve telehealth access in rural America.

“While these telehealth policy changes are critical to promoting telehealth adoption, policies now need to move beyond reimbursement rates to help providers integrate telehealth into routine care,” the blog reported.

Five strategies were identified:

Harmonize reimbursement criteria. More than half of those surveyed cited “uncertain reimbursements” as a barrier to using telehealth, including a wide range of variables attached to those payments by state, federal and private payers.  

“Small independent practices, which made up a large proportion of our survey respondents, often do not have the necessary administrative resources to sift through a long variable list,” the researchers noted. “To promote integration of telehealth, policy makers and insurers will need to reduce the existing heterogeneity of payments to mitigate confusion and uncertainties around billing for telehealth.”

Create billing codes or payment models that cover additional steps taken to use telehealth. Survey respondents noted that a fee-for-service reimbursement plan doesn’t take into account the time and effort spent helping patients access telehealth, and therefore there’s little incentive for providers to adopt telehealth.

“Given the significant adjustments and workflow changes required for telehealth use, value-based or population-based capitation models can better account for the expenses associated with these team-based and technology-enabled models of care,” the researchers said.

Provide coverage for remote patient monitoring. “Remote monitoring is critical for effective telehealth,” the blog points out, yet current billing codes pay for providers to set up and use the platform but not for compatible equipment required by patients. In fact, more than three-quarters of survey respondents said the patients were responsible for buying their own devices.

“Some patients may not have the means to purchase the devices on their own, which can affect the quality of telehealth being delivered and in turn increase the likelihood of adverse health outcomes for these patients,” the researchers wrote. “There is a clear need for insurers to support patients’ access to and training in the use of monitoring equipment at home.”

Incentivize the development of and access to patient- and provider-centered telemedicine. Survey respondents reported that telehealth platforms aren’t always user-friendly, particularly when they’re used by different socio-economic populations. A telehealth service that doesn’t account for non-English-speaking patients or unreliable internet access won’t make the cut.

“Independent primary care practices often lack the capacity to garner such resources and will need policy-level support to address these barriers,” researchers said. “Financial incentives and national payment policies can support the needed advancement in digital health applications and revamp its clinical value and quality for providers and patients. Financial incentives for telehealth vendors are needed to accelerate the building of improved telehealth platforms to address these flaws. National payment policies for telehealth use can also help increase demand on the provider and patient side, which can stimulate telehealth vendors to respond.”

Amend and emphasize malpractice policies. Malpractice policies for telehealth are largely undeveloped, and liability insurance carriers aren’t eager to jump into the space. Providers are often left to wonder what is and what isn’t covered, and how the laws differ in each state.

“The consequence is often an exclusion of telehealth services from the malpractice insurance policies, creating concerns among providers about telehealth use,” the blog states. “Regional health departments should give providers more guidance on legal liabilities related to telehealth. This is particularly true for independent practices that do not work within larger systems, and thus lack the capacity to address the complexities of malpractice policies.”

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