Telehealth demonstrated Its viability during the COVID-19 Pandemic. Where adoption goes from here is dependent on a number of variables.
Bethesda, MD - In late Q1 2020, telehealth utilization surged as patients and clinicians used the technology to safely access and deliver healthcare. The starkness of the shift to virtual care platforms is evident in comparing February 2020 telehealth session volumes to April 2020 volumes, which were 78 times higher. Even as COVID-19 case counts have dropped in the United States, telehealth volumes have stayed at a level that is 38 times higher than the pre-pandemic baseline. With 40% of patients saying they will continue to use telehealth going forward (up from 11% prior to COVID-19) the demand side of the equation is robust – at least in the short-term. In this post we will review some of the industry drivers that will determine if pandemic era telehealth adoption can prove resilient.
Bending the cost curve in healthcare
The delivery of healthcare in the United States remains the most expensive services system in the world. Among industrialized nations, the United States spends the highest per-capita on healthcare, but life expectancy in the U.S. lags that of peer countries and many patients struggle to pay for their healthcare even if they have insurance. These costs continue to steadily increase. According to the Centers for Medicare and Medicaid Services (CMS), the United States will spend $6.8 trillion - or 19.6% of the country’s Gross Domestic Product by 2030. Integrating telehealth into delivery systems offer a path towards reducing the growth rate of healthcare costs. Systems can use telehealth to realize productivity gains, such as increasing the capacity of providers to see patients. By managing a larger volume of patient visits with the same level of provider resources, the marginal cost per patient visit is reduced. One practical method to achieve these productivity gains is to implement asynchronous consultations (also known as store-and-forward). These consultations describe an encounter when the patient and clinician are not localized to the same time point. For example, a specialist can use an asynchronous platform to review patient questions, PCP referrals, clinical notes, and images for a large group of patients in a single time segment. The same specialist may only be able to see one or two patient cases in-person during a similar time segment. Researchers in Ontario were able to demonstrate the generalizability of an asynchronous solution as well as its advantages when compared to real-time video telehealth platforms. Observed benefits included reducing the minimum technology required (asynchronous uses less bandwidth than streaming), being device/browser agnostic, and removing the need to coordinate schedules between patients, PCPs and specialists for live video sessions. As systems continue to grapple with rising costs and staff shortages, telehealth solutions such as asynchronous communication platforms offer an evidence-based solution that bends the cost curve.
Regulations and reimbursement policy has not kept pace with innovation and adoption
COVID-19 turbocharged the adoption of telehealth services across the healthcare industry. According to a survey conducted by the American Telemedicine Association, by April 2020 nearly all primary care physicians (97%) were using telemedicine to treat patients. Telehealth claim lines increased 2980% nationally from September 2019 to September 2020. Despite this explosive growth in adoption, there are still regulatory hurdles facing providers and patients in the post-pandemic era. The regulatory environment, which ostensibly is meant to protect patients and ensure quality care, has not kept pace with rapid innovation and changes in how patients access health care. When it comes to telehealth regulation, there is no single "federal" approach that applies across all states—nor even within all payers within a state. State laws and regulations vary widely from state-to-state with respect to licensure requirements for out-of-state practitioners, scope of practice for providers, whether patients can be treated remotely without an in-person visit first, what types of reimbursement models can be used and for what services, data privacy and security protections (which are often more stringent than federal HIPAA protections), among others. Congress recently granted a five-month extension to the various telehealth regulation waivers (such allowing adults aged 65+ Medicare coverage for telehealth visits regardless of where the patient lives relative to the provider) that were adopted during the pandemic. However, legislation to make these waivers permanent has been slow to gain widespread support in Congress.
CMS is finally getting on board with Virtual Care
As the single largest payer of healthcare services in the United States, CMS’s reimbursement decisions have an outsized impact on the adoption of innovative medical interventions. Prior to COVID-19, CMS would only reimburse for telehealth services in limited instances, such as when the patient receiving the service lived in a designated rural area. There were also requirements that the service use an interactive audio and video platform that allowed for live communication between the provider and patient and that the patient had to be located at an approved local medical facility to participate in the session. Realizing that a lot of these stipulations were raising unnecessary hurdles, CMS began adopting strategies and policies that improved patients’ access to emerging virtual care technologies. Beginning in 2019, CMS started paying for virtual check-ins such as SMS text engagement platforms. These encounters are different from traditional telehealth visits as they are brief, patient-initiated communications with a provider and are not limited to patients in rural areas. In 2020, Medicare began paying providers for “e-visits” (non-face-to-face, patient-initiated communications through a portal like MyChart) if the patient and provider had an established relationship prior to the e-visit. CMS also started allowing Medicare Advantage plans to offer telehealth services as part of a basic benefit plan, which greatly expanded the population of patients with access to virtual care services.
The pandemic has given CMS the robust data needed to evaluate the effectiveness and value of telehealth services. CMS acknowledges that virtual care platforms increase access to care, are convenient, and leverage innovative companies that help improve patient outcomes and reduce costs. The rapid adoption of telehealth and virtual care platforms has transformed the healthcare delivery system. It is important for stakeholders to keep the ball moving forward an ensure that old habits do not turn back the clock on innovation.
To learn more about how MTPPI can help your organization optimize its telehealth and virtual care strategy, contact info@mtppi.org