“The pandemic brought opportunities and long-standing problems to the surface,” said Ann Mond Johnson, CEO of the American Telemedicine Association (ATA) in her address welcoming attendees to ATA2022 at the Boston Convention and Exhibition Center. Lack of access, disparities in care delivery, confusion around regulations and burnout are just some of the problems that have been highlighted over the past two years.
While there isn’t a straightforward solution to the problems Johnson laid out, telehealth can play a major role in overcoming these challenges. Laws and regulations need to support the effective deployment of telehealth, she said: “We have a shared obligation to fix disparities in care and access once and for all. We must use our collective capabilities and voices to meet people where they are when it comes to their health. Together, we can ensure everyone gets access to care when and where they need it.”
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Assessing the Telehealth Landscape Amid Uncertainty
The COVID-19 public health emergency has been prolonged to July 2022, which also extended the use of telehealth waivers. Many in the healthcare industry are hesitant to make lasting investments in virtual care while uncertainty looms about future reimbursement for telehealth.
The ATA has been advocating for permanent access to telehealth services across the care continuum. But what is the “right” proportion of telehealth to in-person health visits? That’s a question Dr. Joseph Kvedar, immediate past chair and senior adviser to the ATA and professor of dermatology at Harvard Medical School, posed during his keynote session, “Now What? Creating Opportunity in a Time of Uncertainty.”
Telehealth usage has dropped off from the height of its use in 2020, but it remains well above pre-pandemic levels. According to FAIR Health, telehealth made up 5.4 percent of the volume of medical claims in January 2022 compared with 7 percent in January 2021 and just 0.24 percent in January 2020.
“There’s no question that there’s been growth. When I ask my patients if they want to do a telehealth or in-person visit they know exactly what I’m talking about. We’ve come a long way,” said Kvedar. “Some people say that’s a victory, and we can all go home. I don’t agree with that, but I don’t know what amount of telehealth is ‘enough.’”
Dr. Joseph Kvedar, Immediate Past Chair and Senior Adviser to the ATA and Professor of Dermatology at Harvard Medical School, explains in his ATA2022 keynote address that patients, providers and payers all play a role in determining the next steps for virtual care and reimbursement.
To assess the current telehealth landscape, Kvedar broke the conversation into three parts:
Patients are enthusiastic: Overall, patients, especially Medicare recipients, are enthusiastic about telehealth. “Patients are not the problem,” explained Kvedar. “We can always do more and make the technology better, but that’s not the problem that’s most in need of solving.”
Providers are reluctant: Kvedar described providers as the biggest challenge to telehealth. A major reason for their hesitancy is reimbursement uncertainty. Many healthcare organizations don’t want to make a big investment without knowing what’s going to happen after the public health emergency ends. It’s possible the emergency will be extended again, but will that be enough time for the industry to put together a long-term reimbursement strategy at a national level and have private payers follow suit?
Reimbursement could include lower payments for telehealth, which would act as a disincentive rather than support for increased adoption. In addition, it’s unclear how audio only and asynchronous telehealth would be handled. Kvedar pointed out that video-based telehealth isn’t always more efficient than in-office visits, which can be detrimental amid today’s provider shortage. He also explained that for some specialists, being in office is more profitable. This is especially true for hospitals.
- Payers are ambivalent: Many payers worry about overutilization of telehealth services in addition to fraud and abuse of the system, according to Kvedar. He says providers need to convince payers that telehealth won’t be overutilized. While the fraud concerns may not be fair, many in the payer space hold telehealth to a higher standard. However, patients are demanding telehealth services, and payers are ready to meet their demands.
Kvedar said other topics being discussed at ATA2022 include the rise of virtual first providers; the establishment of more efficient modes of virtual care such as remote patient monitoring and asynchronous telehealth to spread clinicians across more patients; hybrid telehealth strategies and improved integration; and frameworks for eliminating health disparities using telehealth.
Keep this page bookmarked for our ongoing coverage of ATA2022, which takes place May 1–3, 2022, in Boston. Follow us on Twitter at @HealthTechMag and join the conversation at #ATA2022.