Although use of telehealth services has surged in recent months,
experts say that the permanence of a shift to virtual care is far from certain,
unless regulations and the industry's reimbursement model change dramatically.
Emergency measures adopted by the Trump administration and
states have allowed telehealth providers to significantly scale up in recent
weeks. Anecdotal evidence and claims data released by payers indicates that
telehealth utilization has spiked in turn. However, the authors of a recent paper
from the Brookings Institution and the John Locke Society say those regulatory
changes need to become permanent for the boost in utilization to increase.
"Until recently, telehealth use has largely been limited,
stifled by the ambiguous and often changing regulations on the reimbursement of
doctors and licensure, especially across state lines," the authors wrote.
While states have loosened the rules during the COVID-19
pandemic, in normal times it's illegal for a provider in one state to
administer care to a patient in another. That creates an obvious challenge for
telehealth platforms. Bradley Younggren, M.D., the chief medical officer of
98point6, says that managing state licensing demands a significant outlay for
his company.
Many telehealth-exclusive providers pitch their services as a
lower-cost alternative to traditional care. However, as more primary care
physicians (PCPs) have been forced to enter the telehealth business as a result
of COVID-19, it’s reignited a debate over how to set reimbursement.
According to the Brookings paper, in many states, providers are
required by law to bill telehealth claims at the same rate as an in-office
visit. "The main problem with payment parity laws is that they are
contradictory to telehealth's cost-effectiveness. If telehealth can help reduce
costs of using the health-care system and reduce doctor visits, it is
contradictory to mandate that a service provided through telehealth be paid for
at the same rate as if it were provided in a doctor’s office," the paper's
authors write.
Eliminating parity is not popular among traditional providers,
whose business model is under extreme duress because of the pandemic.
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