Providers say there are a number of logistical, regulatory and educational hurdles that must be overcome for telehealth to reach its potential.
After the coronavirus began spreading in the United States this past spring, telehealth patient rates shot up in response, with some health systems reporting a whopping 4,000% increase in appointment numbers for virtual care.
There’s no doubt, in many practitioners’ minds, that telehealth has filled an existing need both spotlighted and exacerbated by the COVID-19 pandemic. It’s also clear, despite a dip in the initial numbers, that it’s not going anywhere anytime soon.
However, after the initial scurry to spin up an appropriate platform – sometimes within a matter of days – providers are also noting the ways telehealth can be improved.
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Those who spoke with Healthcare IT News for this story made it clear that the benefits of telehealth outweigh the challenges. But there are certainly some shortcomings that should be ironed out. They can be addressed, providers and researchers say, with education, platform improvement and legislation to help telehealth live up to its full potential.
The future of reimbursement
The healthcare professionals we interviewed spoke to the ongoing uncertainty surrounding telehealth reimbursement as a major contributor to dissatisfaction.
“The primary hurdle is the impermanence,” said Dr. Diane Rittenhouse, a senior fellow at Mathematica, whose research expertise includes primary care and innovative models. “The insecurity of the future.”
Although the federal government has made dozens of temporary policy changes to try and ease access to telehealth during the pandemic, it remains an open question which ones will stick. Some, like the relaxation of geographic and originating site requirements, are broadly popular on both sides of the aisle. Others, such as payment parity, remain embroiled in logistics.
The Trump administration added complexity to the situation this week by issuing an executive order in favor of permanent telehealth provisions as well.
For primary care physicians in particular, said Rittenhouse, the uncertainty of payment adds to existing challenges.
“People were seeing patients in the virtual space before they had the reforms to payment to get paid for it. They were doing it essentially for free,” Rittenhouse said. Now, payment reforms have caught up – but it’s unclear how long they’ll remain in place.
“There’s this sense: ‘I like this. Patients like this. We seem to be able to have found success, but how are we going to continue to be paid for it?'” she asked.
Rittenhouse believes the fee-for-service model is not especially well designed for primary care and telehealth.
“It’s really an issue of not being able to survive if they’re delivering care for free. If they don’t get paid for it, if they don’t get reimbursed for it, then how do they function?” she asked.
Another issue for primary care providers, she said, is “change fatigue.”
“We’re asking for a lot of change in primary care over the last couple decades,” she said. “It’s good, and it comes from a good place, but these practices are being asked to add more team members, to work under different conditions, to adopt electronic health records, [and] to develop new population-based quality-measuring systems and reporting systems.
“When you’ve got this chronically underfunded system – or non-system – and you [hear], ‘OK, here’s a pandemic. OK, now you have to see patients in a new way. OK, now we’re going to pay you, but we don’t know how long,'” it exacerbates that fatigue, Rittenhouse said.
“While I think it’s important that primary care providers access the funds that have been made available during COVID-19 to help support their practices, I think more is needed. PCPs don’t have the infrastructure to apply for some of those funds, negotiate for some of those funds,” she said.
Rittenhouse, along with colleagues, recently proposed a primary care service corps to assist with some of these logistics.
“People are ill. Their patients are afraid. Practices are having to shutter. They’re having to take turns. There was a period where they weren’t paid at all. They’re burned out. They have their own mental illness and stress. It’s really, really a tough time,” she said.
Source: Healthcare IT News