Telehealth’s future depends on how Congress will deal with telehealth after COVID. At a recent hearing of the Senate Committee on Health, Education, Labor and Pensions (the HELP Committee), Senators and healthcare experts supported proposals to promote health equity and remove barriers to healthcare. Recent changes that brought telehealth to the home for clients and patients have raised the level of telehealth discussion not only to the national level, but to an international one as well as addressed in the TBHI article, COVID-19: Telehealth Across State Lines & International Borders? As clinicians wait for word from their decision-makers, they are struggling to make sense of their return to the office: Checklist for Getting Back to the Office after COVID-19 Many professionals are also caught in financial dilemmas that leave them with more questions than answers with regard to the future of their practices, as described in this article: Waiting to Exhale about Telehealth after COVID-19. The question that now faces US decision-makers is how to continue telehealth after COVID.
Issues Heading into the HELP Committee Hearing about Telehealth after COVID
In addition to practitioner reluctance, the most widely understood barriers to healthcare are bureaucratic ones. These include restrictive interstate licensing, lack of reimbursement, HIPAA-related patient privacy concerns, and uneven private insurance coverage. These are the barriers that 2020 coronavirus public health emergency telehealth waivers addressed.
But bureaucratic healthcare barriers are not the only obstacles to expanded telehealth access. Social barriers also create inequalities in access to healthcare technology.
There is no doubt telemedicine has reduced unequal access to healthcare benefits in rural areas. But benefiting one patient group while leaving others behind is not true health equity. Many patients living in urban areas have problems connecting with healthcare services, too, but they remain under served.
Inequality barriers to healthcare include:
- Physical inability to reach in-person healthcare services.
- Lack of access to broadband Internet, often because of inability to afford it.
- Other latent structural barriers, including a history of racism in the medical profession.
Pressure Builds to Continue Telehealth after COVID
An encouraging sign for making access to care via telehealth permanent is agreement among politicians, Federal government regulatory agencies, and healthcare professionals in urging that outcome.
- Senators have proposed bills to allow telehealth providers to keep operating under existing waivers. This extension would last for up to 180 after the end of the COVID-19 public health emergency. This proposed legislation is the Equal Access to Care Act. Committee members also proposed a bill to assess the effects of telehealth on improving health outcomes (the CONNECT for Health Act).
- The Federal Trade Commission supports amending CMS rules to encourage distant-site guidelines, and expansion of the types of services that telehealth can deliver.
- The American Telemedicine Association delivered a letter to Congress listing nine requests for additional telehealth funding. These recommendations prioritize telehealth policy development, removing barriers to healthcare in the form of outdated telehealth restrictions, and improving the ability of HHS to gather data on access to telehealth.
The HELP Committee Hearing Includes Health Equity in its Considerations
HELP Committee members advocated steps to reduce bureaucratic barriers to healthcare. These included making the current originating site rule permanent (including reimbursement for patient at-home telehealth appointments). Senators also contemplated authorizing HHS to add to the eligible providers list. Other committee recommendations were for continued delivery of telehealth services to rural health centers and additional telehealth support through grant funding.
The committee recognized the health equity potential for telehealth to remove healthcare barriers for patients. It also considered measures like using remote patient monitoring to reduce the demand for high-speed Internet use.
The HELP Committee hearing confirms that gains in telehealth coverage from the public health emergency must continue. Moreover, telehealth should also play an essential role in advancing access to care by making access to healthcare available to society’s most underprivileged and under-served patients.
How Can Clinicians Voice their Preferences for Telehealth after COVID?
Many national groups are organizing petitions and polls to collect data about member preferences. Some groups are organizing to collect data about issues, such as this petition for extending telehealth practice across state lines. On other fronts, groups such as the American Counseling Association are polling their members to ask for support to petition for Medicare reimbursement for services delivered by the counseling profession.
What Can the Individual Professional Do to Advance The Use and Reimbursement of Telehealth after COVID?
Some professionals are mandated by their ethics codes to be advocates for their profession. Other groups such as the National Social Work Association and the American Psychological Association have ethical codes that require that professionals advocate for social justice. Telehealth is a social justice issue in that it extends access to care in many tangible ways. It decreases barriers such as length of time to accessing care. Telehealth minimizes the many inconveniences involved with accessing everyday health care, such as virtually eliminating office waiting times, reducing child-care and eldercare costs and concerns, reducing transportation costs and delays, parking challenges and time off work. By communicating digitally, professionals can render more accurate and quicker assessments, diagnoses, and treatment plans interprofessionally, reducing the amount of information that is locked in professionals’ offices.
The Telebehavioral Health Institute encourages all professionals to write a single letter containing the recipe outlined below, and mail it to as many decision-makers as possible. Become an advocate for telehealth by drafting a letter that includes:
- Full name, credentials and license number(s)
- 4-5 lines of a case that describes a client or patient’s need for telehealth laws to be changed permanently, and how they could benefit, avoiding the use of any protected health information (PHI) to protect the privacy of the client or patient.
- Directly ask for telehealth support to continue after COVID
Such a letter can be directed to:
- Elected state legislative representatives and governor
- State insurance commissioner
- State regulatory board
- Professional association
Join the Telebehavioral Health Institute and many other visible advocates to become the pebble in the shoe of all telehealth decision-makers.
All comments are invited below.