What if this is as good as it gets?

"What if this is as good as it gets?"

These words from the 1997 romantic comedy that starred Jack Nicholson and Helen Hunt keep coming into my head these days.  I can’t help but recall the ATA annual meeting in June 2020, when it seemed like telehealth was the king of healthcare delivery.  Three months earlier, the March 3 issue of TIME Magazine wondered if the Coronavirus could finally make telehealth mainstream and for the next few years, telehealth was in the news regularly and on everyone’s lips.  

Fast forward to June 2023, and the media are quiet.  According to Fairhealth.org, telehealth amounts to 5.5% of healthcare insurance claims (67% of that is behavioral health). One could argue that those of us who have advocated for multiple-channel healthcare delivery have some achievements to boast about (more on that momentarily).  However, other than the aforementioned behavioral health, telehealth is still a relatively small part of the overall practice of healthcare in the U.S.

There were certainly numerous individuals and organizations, in both the public and private sectors, that contributed to where we are today. But I have to give credit to my colleagues at the American Telemedicine Association (ATA) for their exceptional and unrelenting leadership in advancing telehealth policy. And they are not taking their foot off the gas pedal, as we must continue to address ongoing hurdles to make telehealth a permanent part of omnichannel care. 

Let's take some time to examine the successes, re-examine the vision for what should be and talk about some of the concrete next steps to get there.

First, the successes include:

1. Telehealth is now a household word. Patients and providers alike have had positive experiences with it.
2. At the end of 2022, Congress signed into law an omnibus bill which extended Medicare telehealth flexibilities through the end of 2024, including the telemental health in-person waiver.
3.  The federal government has waived most restrictions on reimbursement through the end of 2024. Telehealth services under the Medicare program will continue to be reimbursed at the non-facility rate (same rate as in person services) through end of 2023.
4. Most EMR systems now have fully integrated videoconferencing capabilities to make it easy for clinicians and patients to interact in this context. 
5. The DEA released a temporary rule that extended the COVID-19 flexibilities for the remote prescription of controlled substances for new and established patients, through November 11, 2023. Additionally, these flexibilities will continue for established patients through Nov 11, 2024.

Now, some of the ongoing challenges:

1. Hospitals and health systems are still disproportionately rewarded for in-person care.
2. The omnibus legislation (noted above) excluded two critical policies: continuing the in-person waiver for the remote prescription of controlled substances and the ability for employers to offer telehealth as an excepted benefit. 
3. Telehealth coverage from private payers is uneven and there is the ongoing threat that telehealth interactions will be reimbursed at a rate less than in-office interactions.
4. We have a long way to go in terms of the integration of non-video modes of telehealth (primarily remote monitoring and asynchronous interactions).
5. The best value proposition we can often come up with for telehealth is patient convenience and/or “it’s the right thing to do.”  We have to demonstrate better value.
6. We need a clearer rule set around reimbursement and a long-term commitment.  2024 is an election year so we really need to get some things done in 2023 to make the reimbursement changes permanent.

To that end there are two recent legislative matters that I want to bring to your attention.

Two congressional hearings just took place to address critical legislation that could impact millions of American workers. First, the House Education and Workforce Committee held a hearing on the Telehealth Benefit Expansion for Workers Act of 2023. This top priority bill would permanently allow telehealth to be an excepted benefit (i.e., allows employers to finance additional medical care), expanding access to care for all employees including for part-time, contracted and seasonal workers who otherwise wouldn’t qualify for employer-sponsored health insurance. I’m pleased to report that this bill passed out of committee with bipartisan support and is now headed to the House Committee on Energy and Commerce for markup. 

A second hearing was held by the House Ways and Means Committee to debate proposed legislation, the Telehealth Expansion Act. If this bill passes, it will permanently extend the exemption for telehealth services from certain high deductible health plan (HDHP) rules, allowing Americans who have HDHP-HSAs (health savings accounts) to receive telehealth services prior to meeting their deductible. The bill was voted out of committee and is on its way to the House floor. Let your members of Congress know you stand with the ATA and ATA Action and urge them to vote yes on this important piece of legislation.

The telehealth policy landscape is complex – and critical to securing virtual care services in our healthcare delivery system. But public awareness, provider acceptance and payer coverage are equally important. Can we pull all of these levers to open the gates to unencumbered telehealth access? And if we do, how good will it get?