Much of the world is holding its collective breath to see what will happen to telehealth after COVID-19. Continued governmental support for telehealth could reduce administrative and financial burdens that maintain telehealth disparities that render access to care difficult, if not impossible for many citizens, including the underprivileged.
The Accelerator Effect of COVID-19 on Telehealth
Prior to March 2020, weekly telemedicine visits averaged 12,000 nationally. Now that number is more than a million visits per week. These extraordinary gains came from extraordinary circumstances which led Federal and state governments to take extraordinary measures, including more telemedicine reimbursement opportunities, easing of state licensing restrictions; and allowing the use of technologies that are not fully HIPAA-compliant.
Regardless, the current COVID-19 emergency will not be permanent. Rollbacks of some emergency measures are already underway, but the extend of those rollbacks is being argued at the legislative level. Many suggestions are now being made for how the many breakthroughs made can be sustained for a vibrant new form of healthcare that significantly includes telehealth after COVID-19.
Support for Telehealth after COVID-19: No Going Back
While uncertainty still exists, it appears from recent events that many telehealth changes will remain in effect.
The Centers for Medicare and Medicaid Services (CMS) is expressing support for lasting regulatory changes that support telehealth after COVID-19. Notably, CMS Administrator Seema Verma has said that she Can’t imagine going back to the pre-coronavirus telemedicine model.
This month, the National Committee for Quality Assurance released updated 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures for 2020 and 2021. These are meant to support better use of telehealth.
Congress is becoming interested in continuing CMS changes to telehealth after COVID-19. This includes legislation that would require the Secretary of Health and Human Services to do a study of healthcare usage during the coronavirus pandemic. Today, in a hearing before the full Senate Committee on Health, Education, Labor and Pensions (HELP) on telehealth after COVID-19, American Telemedicine Association (ATA) President, Joseph C. Kvedar, MD, testified, urging policymakers to “take specific actions before the end of the public health emergency to make access to telehealth services permanent.“
Dr. Kvedar, Professor, Harvard Medical School; Senior Advisor, Virtual Care, Mass General Brigham (Partners HealthCare), and ATA President, continued, “I have seen first-hand the many ways telehealth bridges the gap between a critical provider shortage and a growing patient population – a problem that existed prior to the pandemic, and one that will only worsen.” He also said, “However, we need Congress’s support to ensure patients and providers do not go over the telehealth ‘cliff’ as our nation eventually emerges from the pandemic. We must make sure that essential telehealth services do not abruptly end with the public health emergency, especially as we look to reorient our healthcare system to deliver 21st century care.”
Making Telehealth Work for The Underprivileged
As part of its COVID-19 response, through the Federal Communications Commission (FCC) the Federal government has invested additional grant funds to improve telehealth infrastructure and programs. The FCC states that a purpose of these grants is to increase access to low-income patients. Still, how inclusive the future of telehealth will be depends on how well telehealth providers address the needs of people who can’t use it because of structural and social barriers.
Structural barriers to telemedicine access take physical and social forms. The most significant structural barrier is inadequate access to broadband Internet, which affects practitioners and patients.
Social barriers are more subtle because they are often the result of demographic factors, such as language and cultural norms. For example, even without structural barriers, the availability of telemedicine to a non-English-speaking patient may still of little use. In a state like California, where four in ten residents don’t speak English at home, making medical interpreters available must be part of a comprehensive telehealth solution.
Another social barrier is the effect on inner city residents of limiting the availability of telemedicine to rural areas. The inability of patients to physically get to a hospital or clinic is not confined to the countryside, but is an urban problem, too.
Regulation and Licensing Reform is Only Part of the Answer for Telehealth after COVID-19
Making regulatory and licensing changes permanent is the focus of much of the discussion about the future of telehealth. But we must not forget that invisible barriers make it hard for many already-under-served patient groups to benefit. Only by building telehealth solutions that are culturally competent – along racial, economic, geographic and linguistic lines – can we expect that they will be truly equitable.
If you support telehealth after COVID-19, we urge you to make your voice heard with your legislators. Write to your governor and other legislative representatives. The time is now.
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