The Future of Telehealth: how Covid-19 is changing the delivery of virtual care
House members hear expert testimony, discuss the use of telehealth in America
by Jessica Denson, Communications Director
Washington, DC (March 2, 2021) – Lawmakers today are tackling how best to leverage telehealth as part of America’s health care system post-pandemic.
“This is a bipartisan issue,” said U.S. Rep. Anna Eshoo (D-CA). “Expanding telehealth has been a long-standing issue that we’ve needed to address. I think it’s time to look at making the Medicare reimbursement for telehealth services permanent. Using telehealth has been a bright spot in the pandemic. We should make [it] easier for all patients to access and use.”
The House Subcommittee on Health, which is part of the Committee on Energy and Commerce, just wrapped a hearing entitled “The Future of Telehealth: how Covid-19 is changing the delivery of virtual care.”
Telehealth usage in America skyrocketed in 2020 as physicians looked for ways to limit unnecessary exposure—and reach patients who might otherwise not receive care.
“Almost a year ago today the public health emergency began, and, at the time, telehealth was rarely used by many Americans,” said U.S. Rep. Brett Guthrie (R-KY). “It’s substantially increased during the pandemic. One provider in my district saw telehealth visits go from 5% to more than 80%. These helped doctors stay connected to fragile patients during Covid-19, especially older patients who were at higher risk, so I’m thankful to providers who stepped up.”
That increase in telehealth usage is something several lawmakers say they saw in their districts—in both urban and rural areas.
“As a leader on the rural healthcare caucus our conversations on expanding telehealth to address doctor shortages is no longer a discussion for the future but it’s happening today,” said U.S. Rep. Cathy McMorris Rodgers (R-WA). “Four hospitals in my district scaled up their telehealth visits from 7,000 in 2019 to more than 100,000 visits in 2020. This is more than 1,000% increase in volume.”
In response to the pandemic, lawmakers moved quickly in March 2020 to lift regulations and other barriers to expand telehealth. Those actions contributed to a surge in its use. However, there are concerns as much of the growth, at times, went unchecked because of the immediate and urgent need.
“Our committee has a long history of working to expand telehealth access within Medicare,” said U.S. Rep. Frank Pallone (D-NJ). “But, while there are benefits, we can’t ignore the dangers of telehealth schemes or scams—especially those that target older Americans. We should also look at access and identify any barriers to using telehealth. For instance, we know that many Americans lack the digital literacy or even the basic internet they need for telehealth. We want to make this permanent, but let’s be careful with how we do it.”
Experts from Stanford Health Care, Harvard Medical School, and the American Medical Association, among others, testified early in the day about the opportunities for, challenges to, and dangers of expanding telehealth.
The experts weigh in
“In many ways, telehealth harkens back to when doctors made house calls,” said Dr. Megan Mahoney, Chief of Staff, Stanford Health Care. “As a doctor, I can tell you that seeing someone’s home life can help with understanding their health care needs and outcomes. Telehealth is really a tool in our toolkit. It’s largely substitutive, not additive, to our in-person care.”
Dr. Mahoney shared her experiences as a physician with the Representatives during Covid-19 emphasizing that the lifting of regulations and improving provider reimbursement needs to continue to be a top priority.
“We need the ability to provide video visits to the patients—no matter where they are – rural or nonrural,” she said. “We also need recognition that video reimbursements require the same effort as in-person. Also, the lifting of regulations last year allowed for interstate visits, so people could see specialists. We need a reevaluation, a national view, that allows physicians to continue care for patients across state lines.”
According to Dr. Ateev Mehrotra, an Associate Professor of Health Care Policy at Harvard Medical School, one of the challenges for telehealth is balancing convenience with necessity—meaning if you make health care too convenient you may see overuse or excessive appointments and other abuses of the system.
“Should audio only telehealth visits be covered? That could just end up being a fancy name for a phone call,” explained Dr. Mehrotra “We must ask those questions. It’s key to recognize that in many communities many Americans do not have access to a video visit because they lack the technology or don’t have internet.
“We have to ask if a phone call is sufficient and recognize that it can even be prone to fraud,” he continued. “I’m also concerned it creates a two-tier system where the wealthy get video visits and the poor get only phone calls.”
Dr. Mehrotra added that there are ways to mitigate those concerns such as allowing phone calls for one to two years and using that time to provide the technology, such as devices and internet services, to those who need it most. He also pointed to the potential cost-savings of telehealth including lower overhead per visit.
The cost-saving aspect is something Elizabeth Mitchell, who heads the Purchaser Business Group on Health as its President and CEO, says her members would like to see leveraged.
According to Mitchell’s written testimony, the organization represents nearly 40 private employers and public entities across the U.S. ‘that collectively spend more $100 billion annually…on health care services for more than 15 million Americans.”
“The primary barrier is payment,” she said. “Payment for U.S. healthcare is irrational. We need to change it to a value-based service and reduce physician burden, improve equity, and get better value for the employers and government agencies who are paying the bills.”
Mitchell also believes that expanding access to telehealth technologies can also address injustices found throughout the health care system.
“We know that too often rural communities, low-income communities, communities of color do not have the same access to needed care as others do,” she said. “We believe that telehealth provides a unique opportunity to address those inequities and provide care to low-income communities.”
Dr. Jack Resneck, who sits on the Board of Trustees for the American Medical Association, agrees.
“It’s helped both rural areas and inner-city areas where lack of sufficient medical services has really contributed to health inequities for decades.”
He also says, during the pandemic, telehealth access has created benefits far beyond Covid care and social distancing.
“It has improved patient and physician communications,” Dr. Resneck said. “People on a video visit sometimes tell us more about their living environment or food insecurities and that is helping us integrate that into their care and improve their health outcomes. It also saves the patient transportation time and helps them avoid missing work and childcare issues.”
He also urged Congress to expand high-speed internet (broadband) access to more people as soon as possible.
“We’re constantly surprised with how many of our patients can’t access telehealth options because they don’t have access to the internet,” he explained.
But it’s not just having the access to the technology that matters. Frederic Riccardi, who serves as the President of the Medicare Rights Center, says providing digital literacy is just as important.
“Some clients have not been able to use the tech or feel comfortable with remote care in general. In addition, other clients haven’t been able to find a provider who could use care,” he said.
Riccardi also cautioned against making any changes to telehealth usage and access permanent without more study.
“We know there are inequities in accessing telehealth across demographics,” he explained. “We must move forward with caution, collecting and following the data in a way that recognizes telehealth as a supplement for care.”
The need for better data on long-term use of telehealth is something each of the experts agreed on throughout the hearing.
“There is too little data and ore research, but we believe collectively there is an enormous opportunity to improve value and equity in care with this.
“Large scale studies in a post pandemic environment still need to be conducted to determine telehealth's long-term quality of patient care,” added Dr. Mahoney.
Despite the challenges, the use of telehealth is not likely to go back to pre-pandemic levels. For that reason, Representative Pallone and other lawmakers speaking today emphasized that this is just the beginning.
“We have a unique opportunity to use the lessons of the pandemic and translate them so that critical telehealth tools are used equitably and advance quality of care for all Americans.”
House members quiz telehealth experts on future of virtual health care in America