A new policy brief from Health Affairs and the Robert Wood Johnson Foundation examines telehealth parity laws in the United States. With 20 percent of Americans living in areas that have physician shortages, telehealth could help these underserved U.S. residents obtain access to care — to treat illnesses and monitor chronic conditions.
While the Affordable Care Act (ACA) includes efforts to encourage telehealth services as part of health coverage, it has only been implemented at the federal level through Medicare. Which, if any, telehealth services are covered by Medicaid still remains within the powers of individual states. Telehealth parity laws would also require reimbursement by health plans to providers at similar rates for services delivered in person or via telehealth.
This policy brief looks at the obstacles telehealth faces in becoming a viable and cost-saving healthcare option for individuals and states. Topics covered by this policy brief and highlights include:
What's the background and the law?
This section describes how telehealth works and its benefits to patients as well as the potential savings. For example, some estimate the combination of store-and-forward, real-time communication, and remote patient monitoring usage in emergency departments, prisons, nursing home facilities and physician offices could save the United States $4.28 billion on healthcare spending per year.
The brief also reviews how the federal government has shaped which telehealth services are covered under Medicare, as well as reimbursement limitations. Through Medicaid, almost all states provide reimbursement for live video telehealth — but not all require reimbursement be made at the same rate as in-person services.
What's the debate?
With consumer demand for telehealth services on the rise, the brief describes the views of telehealth opponents who argue that these services are not equivalent, so should not be reimbursed at the same level. Opponents are also concerned that telehealth services could bring about improper diagnosis and treatment.
The brief mentions past research, which addresses many of these concerns. This includes a 2014 study dispelling concerns that the convenience and accessibility of telemedicine will lead to overuse and increased total costs. Additionally, while privacy remains a concern for all of healthcare, many think the risks associated with telehealth are no greater than those posed by the move toward digital records.
What's next?
With telehealth technologies, providers can deliver high-quality care at a lower cost — a critical imperative in the accelerating era of value-based payment. On balance, the benefits of telehealth are substantial, assuming more efforts will reduce or address the risks and challenges.
As a result, Congress is now considering a nationwide Medicare Telehealth Parity Act to modernize the way Medicare reimburses telehealth services and expand coverage for up to 80 percent of Medicare beneficiaries. This would be accomplished by extending the number of qualifying geographic locations and coverage of additional telehealth services.
To reap the benefits of telehealth services, states are likely to move toward full parity laws for telehealth services, and they are expected to gradually remove restrictions that limit providers, locations and services. Instead, states will focus on integrating telehealth into regular healthcare coverage.
As the United States moves from uncoordinated, volume-based delivery of health services to an integrated, patient-centric, value-based model, healthcare delivery will increasingly focus on achieving higher-quality care, improved access and lower costs. Telehealth programs will play an important role in in enabling healthcare organizations to operate more cost effectively and provide high-quality "anytime, anywhere" care to patients.
