Telemedicine: The View from the Doctor’s Office

We’d been closely following developments in telemedicine and digital health innovation long before the pandemic, given its transformative potential to improve health care efficiency. Once COVID hit, we focused on telemedicine as a way for our clients’ employees and their families to safely access care. These days, we’re thinking about the wildly elevated level of engagement with telemedicine and how to leverage it going forward. So I was excited to see a new report that offers a perspective on telemedicine from a critical viewpoint – that of the healthcare provider. 

The Taskforce on Telehealth Policy was convened this summer to make recommendations to Congress about temporary changes, at the state and federal level, relating to telemedicine and remote patient monitoring. The group was led by Alliance for Connected Care, NCQA and ATA and included a broad group of stakeholders. Now available on the NCQA website, the just-released report presents the group’s work in three areas:

  • Patient Safety and Program Integrity
  • Data Flow, Care Coordination and Quality Measurement
  • Telehealth Effect on Total Cost of Care

From the perspective of this benefit consultant and patient, the recommendations in the first two sections looked solid. It’s hard to argue with their suggestions for how to maintain and advance patient safety, or with their ideas for how to guard against fraud, waste and abuse (FWA). Not only are these folks on the front line, they are also very well versed in all the requirements of Medicare, HHS and other governing bodies. So rather than creating new FWA efforts, they recommended HHS integrate telehealth into existing FWA efforts. Makes sense to me. 

I was most interested in where the taskforce would land on the question of payment parity – equal reimbursement for provider visits conducted virtually or in person. The very first sentence in the section on Total Cost of Care expressed what many of us on the plan sponsor side see as a real concern: Among the greatest barriers to broader telehealth adoption are assumptions among policymakers that allowing greater telehealth access will lead to higher utilization and costs.  

Their recommendations around reimbursement were broad, but generally encouraging. They suggest that telehealth services be “reimbursed based on a thoughtful consideration of the value provided and the cost of delivery.” They also acknowledge that the broader value of virtual care includes avoided costs, such as for travel, waiting for a visit, missed work, and back-up child/elder care.  And they recognize evidence of telemedicine’s effectiveness (e.g., in reducing ER visits) and its ability to meaningfully increase access to care (e.g., broader access to mental health services).

The proof point will be how it all comes together in a meaningful way that -- effectively and efficiently -- benefits the patient. What happens next? There are many interested parties and you can be sure that Congress will hear from all of them. The employer voice is an important one, too – since job-based health insurance currently covers, and pays most of the cost, for over half of America. There will be more to come from us on this topic.

 

Tracy Watts
by Tracy Watts

Senior Partner, National Leader for U.S. Health Policy

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