by Mario Gutierrez, Executive Director of the Center for Connected Health Policy’s National Telehealth Policy Resource Center
It seems like we aren’t making much progress but I think, when you look back over time, there have been incremental changes at the state and federal level. So, I think we are getting there.
I’d like to break the challenges down into several areas, the first being federal policy. The Centers for Medicare & Medicaid Services limits the definition of telehealth to only the use of live video, which is its most inefficient form. Rural elderly could benefit from being around their families in their own home and community if they are monitored remotely but instead, because that remote home monitoring is not reimbursed or allowed under Medicare, they have to move to an urban facility. It’s an issue that continues to be confounding. We also know that “store-and-forward” asynchronous telehealth consultation has been proven to be valuable as well as cost-efficient, yet is still not considered for reimbursement by Medicare.
The other kicker is that a medical facility has to be located in a narrowly defined rural location designated by the Federal Office of Rural Health Policy in order to receive coverage for telehealth services. The unintended consequence is that this limits Medicare reimbursement for many rural beneficiaries. For example, if you are a Medicare beneficiary who resides in a rural area, and it takes you two hours to get to your healthcare facility in a town that does not meet the rural definition, then that facility cannot use telehealth to provide you care. And so, we have a system that runs contrary to putting the patient at the center of the healthcare system and bringing the resources to them instead of making them go to the resources. For rural communities, this is absolutely essential.
The glimmer of hope on the horizon is that federal policy is moving to make Medicare more of a managed benefit through Accountable Care Organizations and Medicare Advantage Plans, so you are paying for value as opposed to individual units of service. This makes telehealth more attractive yet, even with these plans, there are limitations on the use of telehealth.
If we can make virtual care available, we can keep people in their homes and communities and allow them to receive care without having to travel long distances when it’s not medically necessary.
The other aspect for telehealth that I think gets lost is the real benefit in the use of virtual communications between providers and patients, particularly if you are living in a rural community. Being able to use virtual means, like a provider communicating with a specialist for a consultation, is a benefit that doesn’t get acknowledged by many states. The notion of changing the culture of healthcare delivery would mean a breakthrough of geographically accessible care. If we can make virtual care available, we can keep people in their homes and communities and allow them to receive care without having to travel long distances when it’s not medically necessary.
This all goes beyond just the healthcare delivery system; it starts with medical training. Our whole medical training system has been geared toward putting the physician at the center of the healthcare system where everything revolves around them. There’s not an emphasis on a team-based approach to care, which considers all of the patient’s needs. That would, particularly for rural areas, encourage human services and all forms of health services to be looked at equally.