Advocates in the health sector are lobbying policymakers to make recent telehealth regulation relaxations permanent, citing improved health outcomes in rural areas as a positive outcome.
- Alan Levine: Executive Chairman, President and CEO of Ballad Health
- Jennifer McKay: Medical Information Officer at Avera Health
- Jim Parker: Senior Advisor for Health Reform at Department of Health and Human Services
- Kripa Sreepada: Health Policy Advisor to Senator Tina Smith
- Senator Bill Frist: Senior Fellow at Bipartisan Policy Center
Speakers from the Bipartisan Policy Center’s webinar titled “Telehealth & COVID-19 in Rural Areas,” are gleaning hope from recent policy changes and advocating for long-term implementation of reforms. Rural areas in America, which make up about 70 percent of the nation’s geography, have historically suffered from health disparities, including lack of access to care. This has been remedied somewhat by the increasing adoption of telehealth, though some barriers still pose a threat to adequate access, such as lack of internet connectivity and lower reimbursement rates. However, now it is up to policymakers to make these hopes a reality for millions of Americans.
Physicians, such as McKay, have seen immense success in the outcomes of their patients thanks to regulatory relaxations. McKay argued that in some cases, telehealth may provide more value to those in rural areas than a face-to-face visit would.
During the pandemic, Avera Health established more than 500 virtual clinic sites across northwestern states and set up a call center that avoided 50 emergency room visits per day. Avera Health also strategically leveraged technology to ration PPE, using iPads in ICU rooms so that physicians and nurses didn’t always have to enter the room. McKay said thanks to telehealth, her patient population was able to avoid a surge in cases. Avera Health also treated more COVID-19 patients in their homes than in the hospital. This increased value goes for physicians as well, and she urged others not to be afraid of it. With telehealth, McKay knows what conversations need to happen with the patient before the visit, allowing more conducive conversations that have strengthened her relationships with patients.
“Working in telehealth has made me feel more like a physician than I have in a long, long time. It forces you to talk to patients. You get undivided time with someone who’s important to you to talk about really important health things. As long as you listen to your patients, they’ll tell you what’s really wrong with them.”
The proven success of telehealth has led to widespread adoption of the practice across Ballad Health providers. Levine said that in Ballad Health’s most recent fiscal year, ranging from July 2019 to March 2020, they only held about 400 virtual visits with patients. In the following two months alone, Ballad Health conducted more than 15,000 telehealth visits. Though, Levine acknowledges that a big barrier for some providers may be getting reimbursed at an appropriate rate, if at all. Levine advocated for payers to reimburse at the same rate as in-person visits, so those who provide care are incentivized to give to those who need it. Particularly for elderly populations on Medicare, Levine noted that many will be scared in the coming months to venture into public spaces, such as a medical facility. Nonetheless, this segment of the population will still need connection to their providers, for physical health, but also just maybe someone to talk to for emotional health in the midst of ongoing isolation.
“The emotional impact is going to be huge,” Levine said in regard to this needed connection.
From a government perspective, both Sreepada and Parker are hopeful as policy makers for some permanent shifts in telehealth regulations that allowed physicians to practice more widely. Parker noted that thankfully FQHCs and RHCs were now able to bill for telehealth. He would like to see this access continued in the future, but a major question remains of whether the increased cost of technology justifies convenience for the patient. While there’s no easy way to rapidly scale telehealth across the country, the HHS is actively looking at what can be done going forward.
“Consumer expectations are likely changed moving forward,” Parker said. “ We’re going to need to look at the data and envision a soft landing for telehealth. Hopefully there’s no hard stop.”
In Minnesota, Sreepada and Senator Smith see allowing permanent changes in telehealth policy as a part of giving hope to the community. They have been listening to feedback from providers telling them how the relaxation of some policies, such as interstate practice with border states, has immensely helped them serve their patient population. Now, the office is trying to analyze which services are best suited for which modalities. In rural areas, access to broadband can be limited, so audio may be the only option. This is one of the many areas on which the senator’s office is doing a cost-benefit analysis.
Along the same lines, one of Parker’s main worries is that if a favorable reimbursement policy is implemented at the end of the pandemic, the success of telehealth may stall in areas where a sound infrastructure of technology and connectivity is severely lacking.
McKay said that the telephone is still an important piece of technology for the elderly population, but if they have access, many are also comfortable with video calls, as that is how many stay in contact with children and grandchildren. It’s something to keep in mind going forward. Levine argued that as the retirement population ages, they will expect to have the option to attend a virtual visit.
“You have to be looking at what the marketplace is going to be demanding whether we want it to or not,” Levine said.
And for those who may not have providers in their state who can furnish the telehealth service they need, Sreepada said it’s just common sense, even in the long-term, to let up on cross-state licensing restrictions, especially for border states.