Uncertainty about the future of coverage for telehealth could hamper its use
Download mp3 (12.01 MB)The use of telehealth increased dramatically during the COVID-19 pandemic. And now, an advocacy group is urging Congress to make permanent the changes that had been made on a temporary basis during that time.
In fact, the American Telemedicine Association is calling 2024 the telehealth “Super Bowl,” since many of the rules that’ve been in place for the past few years to expand access to telehealth are set to expire at the end of this year.
Tara Sklar is professor at the University of Arizona’s James E. Rogers College of law, where she teaches health law. She’s also the associate director of telehealth law and policy with the UA College of Medicine’s Arizona Telemedicine Program.
Conversation highlights
What is the state of patients access to telehealth in Arizona?
SKLAR: Sure. We have a really strong bipartisan Legislature support for telehealth here in Arizona. It's really quite remarkable. Part of the issues that providers, health providers have with whether or not they're gonna provide telehealth services is whether or not they're gonna get paid to do so and how that compares with seeing a patient in person.
So, part of what Arizona has passed, along with about half the other states in the country, is called payment parity, where health care providers receive the same amount for services they provide via telehealth as they would for in person. So that's made a really big deal.
And we also have — there's a different ways in which you can provide telehealth. You know, you can have the classic synchronous, you know, on your computer or on your phone, talking to your provider. Or you can have asynchronous where it's a text message through a secure patient portal that's being exchanged or something like that or with different devices, tracking your, your vital signs, like your blood pressure and weight.
So all those things are considered telehealth here in Arizona, whereas a lot of other states really kind of carve out what is considered reimbursable by Medicaid or private payers. So, anyway, to answer your question in a nutshell, Arizona has taken a really comprehensive view of telehealth, and a lot of these patients as well are on Medicare, which is federally reimbursed. So that's, you know, also in the headlines right now as well.
Are there particular types of providers or specialties where we're seeing more use of telehealth than others?
SKLAR: Sure. Absolutely. By far, the largest specialty that's being accessed through telehealth is for behavior health services. That's here in Arizona and across the country. It, you know, really skyrocketed during the pandemic, but it still is the levels are still much higher than they were pre pandemic to access a mental health provider.
And I think, you know, most people can get a sense of why it is. That would be the case because you know, it really is talking you don't need to necessarily have excess equipment or monitoring equipment, that hands on approach that you may expect in a physician-patient encounter.
Is there an effort to roll this back? Are there people saying: "We're doing this a little bit too much. We really should be getting patients back in providers offices?"
SKLAR: Yeah, that's a really interesting question. I think for the most part, it is people really welcome it as an option, both the providers and the patients ... And then I think so just think about your question, at this point in time in 2024, but if we could just extend it out just a little bit to maybe 10 years from now 2034, we're already seeing, you know, long wait times and trying to see a provider, long ED, emergency department, wait times. A much older population going forward, particularly in the 85 plus bracket. So, for folks to say, you know ... patients should come more in person to the office is one thing. But knowing that we're already experiencing such a high demand for health care and concerns with being able to meet it with our current providers. And in these traditional settings. I think, you know, not only to think about it at this point in time, like, really how can we triage care in a way where, you know, things that can be handled via telehealth can be handled that way. If you need to come in person, for whatever reason, you know, able to allow that. But to simply to discount it is like no, only as a binary approach, only in person or only virtual, I think it's really missing the mark when it comes to — how are we going to prepare a health ecosystem for the future that's going to have a older population and not the providers that we need to care for us as we get older?
Well, I guess there's sort of a baked in certain things you just can't use telehealth for anyway — a strep test or a blood test. That's a lot harder to do over a screen or over the phone than it is to actually be in the same room as your provider.
SKLAR: I mean, that's a great point. I mean, the other thing that's interesting about what's happening right now with — will telehealth continue to be reimbursed for all these different modalities that I just mentioned. But, you know, those things that you just said are all diagnostic tests, which are rapidly increasing with patients abilities to do those types of things on their own. And then, you know, go to a mobile clinic or mail it in or go to some kind of community center of sorts — and not necessarily the provider's office.
So I think, you know, what's happening right now is we're in this sort of vague ambiguous area where the states really vary in how they're approaching telehealth. We're currently at a cusp with, you know, Medicare still in this temporary staging of temporarily extending reimbursement but not permanently. So that's kind of having an issue on these technologies that you've just mentioned where, you know, they are rolling out for those types of procedures. I even saw a pap smear one the other day. But if we continue to have this uncertain climate, you know, that's gonna keep delaying that reality.
But it could happen, you know, for different things, of course, there are gonna be situations where in-person care may be needed, but just to allow more options. I think is it could happen more quickly if there was more certainty in what was going on both in different states and nationally.
So when you talk about certainty versus uncertainty, is this an issue of Congress making this kind of coverage — especially for Medicare — and alerting the states that they should just make this permanent, as opposed to continuing to temporarily extend things from the COVID-19 era?
SKLAR: Yeah, that's a really big piece of it. I mean, as a if you think about this from like a provider's perspective, if you're not currently providing health care via telehealth or you're only doing it in, you know, for certain certain patients in certain circumstances. If you don't know if Medicare is going to continue to reimburse it, reimburse you for that type of care.
And that, and at what level I remember I mentioned parity earlier. Would you be reimbursed at the same rate for in for that usually would for an in-person service? Like what is your incentive for adopting your staffing, adopting your technologies, changing your policies and procedures to really make sure that you're protecting patient privacy in a virtual care environment. How much a provider invests, until they have some sense of, you know, without a doubt, Medicare will continue to reimburse at the same level as they would for in-person services.
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