Sharon Radtke from Milton, Vt., knows the value of telehealth. During a recent Capitol Hill briefing, Sharon described how she used telemedicine to manage a flare-up of her rare, blistering skin disease that required the knowledge of a specialist — located nearly 400 miles away in Philadelphia.
Telehealth is a “godsend” for Sharon, allowing her to manage her rare disease and to participate directly with her husband’s doctors during his telehealth visits — something that has not been possible during a pandemic when only the patient and doctor can be in the room.
In the coming weeks, Democratic and Republican senators and representatives will debate several proposals to extend telehealth provisions that were put in place during the COVID-19 public health emergency.
What we found should help shape telehealth policy going forward.
The potential for telehealth to reduce disparities is significant — because it allows for the delivery of care in places where doctors aren’t as abundant. And to ensure flexibility in the system during the pandemic and after, patient preference should inform whether visits should be in-person or virtual depending on their specific disease, if they have a compromised immune system, mobility and transportation challenges, geography, care provider access and privacy needs.
Patients want telehealth technology that:
- Is designed and tested with diverse patients,
- Allows care partners to join,
- Supports multiple languages, and
- Is accessible without a computer via telephone.
That is why the NHC joined 34 other national patient advocacy and health organizations on a set of Principles for Telehealth Policy.
First, we believe telehealth policy can improve access through equitable coverage, with services covered by all health plans including, but not limited to, Medicare, Medicaid, the ACA Marketplace, and other federal and state regulated commercial health plans.
Second, telehealth policy should ease technology barriers. Telehealth services should be equitably available through easily usable technologies that are accessible to people with disabilities, with limited English proficiency, and limited technology. The option of audio-only communication is especially important for rural and low-income populations, as many of these patients lack internet access.
Third, telehealth policy should preserve and promote patient choice. A patient should have the opportunity and flexibility to choose whether they will access care in-person or via telehealth technologies. In addition, patients should have limited out-of-pocket costs for telehealth services and be no more than what they’d pay for an in-person visit. Insurers should not incentivize nor disincentivize patients from using one care site over another — the choice should be based on the right care setting for the patient’s individual needs.
Fourth, telehealth policy should remove geographic restrictions, which place a burden on and can limit both patients and providers when evaluating treatment options for optimal care. This includes allowing providers to practice across state lines through telehealth services increasing access to care and improve care coordination for patients, particularly in underserved areas.
Dr. Marcus Snow, a rheumatologist based in Omaha, Neb., also described the importance of keeping temporary flexibilities that enable physicians to bill Medicare for visits done with patients in their homes. Prior to the pandemic, patients who had a “televisit” with Dr. Snow still had to travel to a clinic to meet with him virtually in another clinic. He described this “old way” of doing telehealth as awkward and ultimately unworkable.
In addition, remote monitoring is essential for patients with chronic conditions. Allowing providers to access patient information in real time could help reduce emergency room admissions and improve health outcomes.
Fifth, telehealth policy should clearly define what telehealth services are covered and what technology providers must use to be compliant with patient privacy, disability access, and civil rights law. This information should be transparent and easy to understand for consumers.
Finally, as telehealth becomes more common, data must be collected and more research must be conducted on the usage and outcomes of telehealth, with special attention to promoting health equity to determine how telehealth technologies should be designed and implemented so that all populations have equal access to their potential benefits.
We know that better access to health care equals better outcomes in the long run, ultimately reducing cost. The 160 million Americans with chronic diseases or disabilities and their family caregivers want and need this valuable tool to achieve their best health outcomes and live their best lives. Congress must act now.