Uncertainty about the future of telehealth coverage could hinder its use

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 temporarily during that time.

In fact, the American Telemedicine Association is calling 2024 the Super Bowl of telehealth, as many of the rules put in place over the past few years to expand access to telehealth will expire at the end of this year.

Tara Sklar is a professor at the University of Arizona James E. Rogers College of Law, where she teaches health law. She is also the Associate Director of Telehealth Law and Policy for the Arizona Telemedicine Program at the UA College of Medicine.

Highlights of the conversation

What is the state of patient access to telehealth in Arizona?

CLEAR: For sure. We have very strong bipartisan legislative support for telehealth here in Arizona. It’s really quite remarkable. Part of the issues healthcare providers and providers have about whether or not to offer telehealth services is whether or not they will be charged for doing so and how it compares to seeing a patient in person.

So part of what Arizona, along with about half the other states in the country, has gone through is called payment parity, where health care providers are paid the same amount for the services they provide through telehealth as they would do in person So it’s gotten really big.

And we also have different ways of providing 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 an asynchronous text message through a secure patient portal that’s being exchanged or something like that or with different devices, tracking your vital signs, like your blood pressure and weight.

So all of these things are considered telehealth here in Arizona, while many other states really carve out what is considered reimbursable by Medicaid or private payers. So anyway, to answer your question in a nutshell, Arizona has taken a very comprehensive look at telehealth, and many of those patients are also on Medicare, which is federally reimbursed. So, you know, it’s in the headlines right now, too.

Are there particular types of providers or specialties where we are seeing more use of telehealth than others?

CLEAR: For sure. Absolutely. By far the largest specialty accessed through telehealth is behavioral health services. This is here in Arizona and across the country. You know, it really skyrocketed during the pandemic, but still the levels are still much higher than they were before the pandemic to access a mental health provider.

And I think, you know, most people can understand why that is. That would be the case because you know, it’s really talked about that you don’t necessarily need an overabundance of equipment or monitoring equipment, that hands-on approach that you can expect in a doctor-patient encounter.

Is there an effort to reverse this? There are people who say, “We’re doing this a little too much. Should we really be sending patients back to providers’ offices?”

CLEAR: Yes, that is a very interesting question. I think for the most part people appreciate it as an option, both providers and patients… And then I think you just think about your question, at this point in 2024, but if we could extend it a little until maybe 10 years from now in 2034, we’re already seeing long wait times and trying to see a provider, a long ED, an emergency service, wait times. A much older population in the future, especially in the over 85 age group. So for people to say, you know…patients should come in person to the office more is one thing. But knowing that we are already experiencing such high demand for health care and concerns about being able to meet it with our current providers. And in these traditional settings. I think, you know, not just to think about it at this point, how, really, how can we choose care in a way where, you know, the things that can be managed through telehealth can be managed from this way If you need to come in person, for whatever reason, you know, you can afford it. But just discounting it is like no, just as a binary approach, just in person or just virtual, I think is really missing the mark when it comes to how we’re going to prepare a healthcare ecosystem for the future that it’s going to have. an older population and not the providers we need to look after us as we get older?

Well, I guess there’s kind of baked into certain things that you just can’t use telehealth for a strep test or a blood test. This is much more difficult to do from a screen or over the phone than it is to be in the same room as your provider.

CLEAR: I mean, that’s a great point. I mean, the other thing that’s interesting about what’s happening right now with telehealth will continue to be reimbursement for all these different modalities that I just mentioned. But, you know, the things you just said are diagnostic tests, which increase rapidly with patients’ ability to do these kinds of things on their own. And then, you know, go to a mobile clinic or mail it or go to some kind of community center and not necessarily the provider’s office.

So I think that, you know, what’s happening now is that we’re in this sort of vague and ambiguous area where states really vary in how they approach telehealth. We’re currently at a cusp with, you know, Medicare still in this temporary stage of temporarily expanding reimbursement, but not permanently. So that’s having a problem with these technologies that you just mentioned where, you know, they’re being implemented for these types of procedures. I even saw a Pap test the other day. But if we continue to have this uncertain climate, you know, that will continue to delay that reality.

But it could happen, you know, for different things, of course, there will be situations where face-to-face care is needed, but just to allow more options. I think it could happen more quickly if there was more certainty of what was happening both in different states and nationally.

So when you talk about certainty versus uncertainty, it’s a matter of Congress making this kind of coverage especially for Medicare and alerting states that they should make it permanent, instead of continuing to temporarily extend the COVID-era stuff— 19?

CLEAR: Yes, it’s a big part of it. I mean, if you think about it from a provider’s perspective, if you’re not currently delivering health care via telehealth or you’re just, you know, for certain patients under certain circumstances. If you don’t know if Medicare will continue to reimburse you, it will reimburse you for this type of care.

And that, and at what level I remember I mentioned parity before. Would you be reimbursed the same price for admission as you would normally be for an in-person service? Like what’s your incentive to adopt your staff, adopt your technologies, change your policies and procedures to really make sure you’re protecting patient privacy in a virtual care environment. How much a provider invests, until they have an idea of, you know, certainly Medicare will continue to reimburse at the same level as it would for in-person services.

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