Building on telehealth’s momentum

It’s been said that Covid-19 telescoped the deployment of telehealth technology that might have taken years into weeks, and that is true. The administration waived regulations that had served to raise the cost of the technology, and increased reimbursement to parity with in-office visits, addressing two key obstacles that had constrained its adoption.

By some happy coincidence, telehealth technology and our digital infrastructure had matured to the point that it could support far broader use just when it was needed. Multiple available technology products were reasonably user-friendly and generally affordable, and the need was there given that across the nation, it was telehealth or nothing.

Now we are at a critical juncture. The regulatory waivers and increased reimbursement levels were only temporary, which means as a nation, we must decide whether we will continue to marginalize telehealth technology or allow providers to find ways to integrate it into our care delivery infrastructure.

Numerof & Associates just completed an in-depth research project with a sample of executives representing over 40 IDNs, academic medical centers, and community-based hospitals across the country to understand their experience with telehealth and where they think this innovation goes next. As is usually the case in healthcare, there was a small segment of forward-thinking organizations who were using telehealth before the pandemic. This segment of providers includes most of the organizations that have made a meaningful commitment to value-based contracting—they realize if they can deliver the same or better care at lower cost, it’s a win. Sure enough, the experiences of these organizations’ patients and clinicians only reinforced their ongoing efforts to further integrate the technology into their care delivery process.

But the overwhelming majority of provider organizations had little or no experience with telehealth prior to the pandemic. Because these organizations rely so heavily on fee-for-service reimbursement, the paltry payments and complex regulation of telehealth left them with little curiosity about the technology until Covid-19 struck. Some of them had a task force that met periodically to talk about how telehealth might fit in when they got around to it, but few had more than meetings or a small pilot to point to.

This latter group is the target for what comes next from a regulation and reimbursement point of view. Since most of this latter group is waiting to find out what the regulation and reimbursement will look like, the answers will determine what they do next.

Telehealth was a specific agenda item at the Sept. 3-4 meeting of the Medicare Payment Advisory Commission, where these exact recommendations were discussed. There, handwringing about potential fraud by telehealth companies, plus preliminary data on quality of care that offered mixed support for telehealth, became the rationale for a recommendation to limit some of the telehealth expansions to just those clinicians participating in Advanced Payment Models rather than to all fee-for-service clinicians. This restrictive recommendation would exclude physicians not participating in APMs from being reimbursed for providing telehealth services to patients outside of rural areas, or for providing telehealth services to patients at home. Another recommendation was to return telehealth reimbursement to pre-pandemic levels.

This is the kind of thinking that will keep our healthcare delivery system stuck right where it is. It reflects a complete lack of understanding regarding the drivers of change in healthcare – even as most of the country is screaming for that very change – and not to mention, the logic is incredibly flawed. Who would think that micro-managing the use of an innovation and reducing reimbursement to the stifling pre-pandemic levels is a recipe for stimulating intelligent uptake?

The truth is that delivery organizations that take accountability for cost and quality seriously are already using telehealth. It’s an important part of the answer to their problem – how to deliver care that is as good or better, at a lower cost.

But for the majority of provider organizations whose involvement in alternative payment models is little more than window dressing, telehealth is irrelevant. The problem for these organizations is maximizing revenue from each patient encounter, not optimizing health outcomes at lower cost. For them, telehealth is a solution to a problem they don’t have.

As we start to see the light at the end of the pandemic tunnel, healthcare organizations have a lot of momentum with regards to telehealth. The technology infrastructure has been put in place. And our research indicated that many physicians who hadn’t paid attention to it previously have discovered that it has value, and many patients have likewise discovered that telehealth makes more sense for some situations.

We’re at the point today where more people investment is needed to evaluate how, when, and where to best use the technology, and where most provider organizations are waiting for payers to come out with answers to reimbursement and regulatory questions before they expend more resources. Realistically, if it’s not worth the effort, they won’t.

That’s why Congress and HHS can’t afford to dither, or worse yet, to flirt with Luddite ideas like the Medicare Payment Advisory Commission was discussing. Rather, it must open the doors to innovation!

While it’s true that innovation sometimes creates opportunities for those who would game the system, it also creates opportunities to improve it. Those who can’t recognize telehealth’s potential won’t use it. Those who can will be grateful for it, and healthcare consumers grateful in return.

Michael Abrams, MA, is the co-founder and managing partner of Numerof & Associates, a firm that helps businesses across the health care sector define and implement strategies for winning in dynamic markets.