Addressing payment parity between telehealth and in-person visits
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Neil S. Calman


Addressing payment parity between telehealth and in-person visits

August 19, 2020

As our state shut down in March and people were urged to stay inside, the Institute for Family Health quickly transitioned our care to telehealth systems to ensure that our patients were able to continue receiving care in the safety of their homes.  The medical world has long flirted with the concept of telehealth, but the COVID-19 pandemic forced it into the mainstream despite the lack of payment parity from most payers for the virtual services provided. This is especially true for audio-only visits, which often occur with patients who either lack the resources for video meetings (broadband access and a video-enabled phone with data) or don’t have technological literacy. Without concrete action and pay parity, this has the potential to aggravate disparities in access and quality of care for marginalized patients.  If physicians lose incentives to accommodate patients who can only utilize audio-only visits, these patients face the loss of access to providers who treat them.  Is our message to those patients is “risk COVID infection or forego treatment” allowing chronic conditions to go untreated and unmanaged? Otherwise, the massive losses in revenue experienced from the differences in payment as patients choose to stay home to protect themselves and their families could force providers and health centers in high need areas and medically underserved communities to shut their doors. A second COVID wave has the potential to entirely devastate these organizations and providers leaving a vacuum of care for our communities most vulnerable folks.

Telehealth has often been seen as a disrupting force within the world of medicine where face-to-face interaction remains the only marker of patient care. However, even in a post-COVID landscape the utility for telehealth remains, especially for patients with chronic conditions or patients who utilize healthcare at higher rates. Peer-reviewed research suggests that telehealth may be associated with better patient outcomes, satisfaction and medication adherence. Having that option to receive care from home, when deemed appropriate by a provider, will allow patients who struggle with childcare, mobility, or transportation to access high-quality and appropriate care. Telehealth could also prevent unnecessary emergency department visits as patients will turn to a provider first before traveling to and waiting in an emergency room.

In order to fully operationalize telemedicine, patients should have basic equipment and knowledge to monitor their health. Medical equipment such as blood pressure monitors for patients with hypertension, blood glucose meters for patients with diabetes, peak-flow meters for patients with asthma, scales for people with congestive heart failure and oximeters for those with COVID infections should be provided with as few barriers as possible.

Concerns exist as we wade into the uncharted territories of telehealth such as fraud and abuse. The conditions for reimbursing in-person visits can be defined and adjusted for telemedicine to mitigate abuse. Additionally, if insurance companies and regulators are able to track and identify fraud and waste among in-person visits, regulations and safeguards can be implemented to identify fraud in telehealth as well.  Penalties can be implemented for falsifying telemedicine visits and services. Perhaps a full integration of telehealth might influence different payment methodology, such as a capitation.

Amidst this national public crisis is an opportunity to transform our healthcare system into one more accessible and thereby more equitable way to receive care. Failure to innovate may perpetuate the widening disparities by income that we see today, and even more dire, force providers to shut their doors under the weight of revenue loss from the pay disparity as patients continue to choose telehealth over in-person visits.  State and federal legislators can finally recognize the technology disparity that exists in our country, and expand and subsidize utilities, such as at-home internet, and equipment, such as smartphones and home medical equipment, to ensure that all patients will have the option to use telehealth. Capital grants to organizations that serve marginalized communities will aid in developing the infrastructure to continue telehealth in a responsible way. To ensure the continued viability of health providers and centers, legislators and insurers must address the pay parity between telehealth and in-person visits and fully ensure that all types of visits, including audio-only, are reimbursed in a way that allows our continued operation. The stakes for the health of our communities are too high to make inaction an option.

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A blog dedicated to the fight for social justice, logic, efficiency, quality and compassion in the way health services are delivered, paid for and regulated. My hope is to engage with you in a bold conversation of health care issues – and share my perspective as a physician, as CEO of a non-profit health care system, and as one who seeks to make the lives of those around him happier and healthier.

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