Telehealth is here to stay; reimbursement needs to follow

September 7, 2020

It will take more than a face value commitment to telehealth for physicians and patients to feel the impact.

At the beginning of the COVID-19 pandemic, Congress recognized the immense need for virtual care. It quickly waived statutory barriers previously in place, enabling expanded access to telehealth and providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually. But these revisions were temporary and will soon expire. This is an issue for two reasons. First, patients have expressed their interest for using telehealth, and using it to continue their relationship with their trusted physician. Second, the value of telehealth extends beyond the pandemic.

Since early June, the positive test rate for COVID-19 cases has nearly doubled with more than 66,000 cases reported daily. Given the rise in cases and the trajectory of the virus, White House coronavirus advisor Dr. Anthony Fauci recently commented that COVID-19 may never be eradicated. When it does eventually come under control, telehealth will continue to be an ingrained part of healthcare delivery. It is and will remain critical to ensuring patients have access to safe, effective. and flexible care options, and physicians are able to maintain revenue both during and beyond COVID-19. Telehealth services need to be reimbursed as a result.

Telehealth Has Been a Lifeline

Over the last five months telehealth has proven essential for patients that needed to maintain therapy regimens, be triaged safely outside the physical walls of the practice and be seen virtually for preventative care visits.

Telehealth will continue to be a necessary component of ongoing patient care and engagement long after the current health crisis ends. However, lack of permanent reimbursement remains a significant concern. According to a recent survey of Updox customers, 55% of physicians who responded see lack of reimbursement as a concern post-COVID. At a time when many practices are facing financial hardships, provisions for telehealth reimbursement are not only essential for access and continued health and safety of patients, but are also necessary for the health and stability of physicians.

Calling for Reimbursement Reform

While at this point the federal government has not yet made permanent provisions for telehealth reimbursement, many options are now on the table. The Trump Administration recently proposed permanently expanding telehealth benefits for Medicare beneficiaries beyond COVID-19 and advancing access to care in rural areas. This is an important step; however, more wide ranging efforts are needed.

Many, including physicians, legislators, and advocacy groups, have spoken up about the need for payment reform. For example, the Community Health Care Association of New York State and the New York State Council for Community Behavioral Healthcare have recently called on policymakers to make permanent telehealth measures that have been implemented during the COVID-19 crisis.

Reimbursement should be addressed at both the federal and state level, and there are multiple provisions that should be taken into consideration by regulators. Many physicians and organizations are calling for the following: 

  • States working with advocacy groups to understand the needs of their specific regions, and supporting telehealth modalities accordingly
  • Telehealth visits being reimbursed on par with in-person visits
  • Elected officials increasing regulatory flexibility such as not requiring in-person visits before telehealth visits
  • The removal of obsolete restrictions on the location of the patient to ensure that all patients can access care at home
  • Maintenance and enhancement of HHS’ authority to determine appropriate providers and services for telehealth
  • The ability for Federally Qualified Health Centers and Rural Health Clinics to furnish telehealth services after the public health emergency
  • Making permanent the Health and Human Services (HHS) temporary waiver of authority for future emergencies

The industry has recognized that telehealth is essential to the health and safety of patients and staff, preventative care, and reducing healthcare costs, as well as ensuring the stability of providers; however, it will take more than a face value commitment to telehealth and an overhaul in payment models for physicians and patients to feel the impact.

This is a critical topic for physicians and practices. Legislators need to hear from their constituents about the importance of moving legislation forward. Providers and patients can call or write to share their stories of how telehealth has positively impacted lives. There is power in numbers, and providers should also look to join in advocacy efforts of their professional associations. The American Medical Association, American Academy of Family Physicians, and American Academy of Pediatrics are just a few of many associations actively advocating for telehealth and providing resources to their members. The industry must work together and stand with physicians and advocacy groups in supporting proactive action until this issue is addressed. The pandemic changed the way we deliver healthcare. Reimbursement needs to follow.



About the Author

Michael Morgan is CEO of Updox. With a successful track record in helping organizations use technology to transform the way healthcare is delivered, Mike has more than 25 years of healthcare leadership within software, behavioral health, and HIT organizations. Updox was named to the Inc. 5000 list of fastest-growing companies in America for the past six consecutive years.