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Medical Providers See Promise in Telemedicine

Doctors at rural health clinics are realizing that telehealth could have health equity implications, and are interested in maintaining their telehealth programs, but state and federal rule changes that made telehealth work during COVID may not last. Mei Wa Kwong of PHI’s Center for Connected Health Policy comments on changing telehealth rules and health equity.

  • Monterey County Now
a doctor in a white lab coat holding a cell phone

When shelter-in-place began in March 2020, patients at the Big Sur health center started canceling their appointments. This didn’t seem like a huge issue at first, when the pandemic lockdown was only scheduled to last two or three weeks. But as it became clear that we were in this for the long haul, it became apparent that care at this rural, nonprofit health clinic needed to continue.

Things couldn’t proceed as normal, though – “[Patients] didn’t want to come in and be exposed,” Executive Director Sharen Carey says. “And we also didn’t want anyone to come to the Health Center who didn’t need to be there.” The nonprofit needed to find another way.

Enter telehealth, which the federal Health Resources Services Administration defines as “the use of electronic information and telecommunications technologies to support long-distance clinical health care,” and the California Department of Health Care Services defines as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.”

That’s a lot of words, but essentially it all boils down to using video or phone to conduct doctors’ visits, allowing patients to stay home and, during a global pandemic, avoid unnecessary exposure.

Clinics that never would have invested the time and resources to make this option available before COVID-19 were all but forced to by the reality of the pandemic. And as they use it, doctors at these clinics are realizing that telehealth could have health equity implications for patients who, because of livelihood, living situation or transportation issues, traditionally struggle to get into a medical office.

Some of them would like to keep using telehealth post-pandemic. But unless some underlying challenges get resolved, it will be hard to keep it.

Telehealth in the Before Times was largely restricted by policies around insurance reimbursement. The patchwork of different state, federal and commercial policies, and the fact that some made it all but impossible for providers to get paid for services delivered via video or phone, created a kind of “why bother” attitude, says Mei Wa Kwong, executive director at the nonprofit telehealth policy resource center Center for Connected Health Policy.

Why bother, that is, until COVID changed everything.

Under the currently ongoing pandemic public health emergency, Medicare, Medi-Cal and commercial insurers all relaxed restrictions, allowing doctors to get paid for conducting visits virtually. This, telehealth advocates say, is a silver lining to locked-down life. The specifics of the flexibility are a little different for federal, state and commercial insurers, but the overall trend is toward more permissive policy.

At the federal level, Medicare’s telehealth reimbursement policy was “one of the most restrictive” before the pandemic, Kwong says. The national health insurance program would only pay providers for virtual services in certain cases – when a person lived in a very specific and narrowly defined “rural area” for example. But this changed quickly in March 2020. Under the so-called “1135 waiver authority” the Center for Medicare and Medicaid Services erased its previously held restrictions.

Medi-Cal, conversely, actually took a fairly “progressive” approach to telehealth, even before the pandemic, Kwong says. Compared to other states, the changes that Medi-Cal made to allow more telehealth were “pretty minimal.”

Commercial insurers in California, finally, were lined up to undergo a policy shift of their own at the beginning of 2021 when Assembly Bill 744 went into effect, requiring pay parity for telehealth and in-person visits. Before AB 744, when a doctor’s office billed an insurance company for a visit, they could often expect to collect more for an in-person appointment. But that has changed.

Kwong says all California lawmakers did was essentially “move up” the start date for this legislation to the beginning of the public health emergency. But according to Denise O’Laughlin, vice president of employee benefits at Leavitt Central Coast Insurance Services, insurance companies have been proactively offering and encouraging the use of telehealth services by their clients in the past few years.

Kwong says future policy is exactly what the federal government and states, including California, are currently considering. The big question now on everyone’s mind: “We made all these temporary moves, what do we want to keep permanent?”

When it comes to Medi-Cal, Kwong says there are essentially two routes to purposeful policy change – a legislative route and an administrative route. There are currently efforts on both in progress.

Click below to read the full story in Monterey County Now.

Originally published by Monterey County Now

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