Attendees at the Mid-Atlantic Telehealth Resource Center 2017 Telehealth Summit (MATRC) www.matrcsummit.org held April 2-4, heard Ateev Mehrotra MD, Associate Professor of Health Care Policy and Medicine at Harvard Medical School, discuss thoughts, ideas, and challenges related to healthcare.
The first issue concerns telemedicine parity laws. As Dr. Mehrotra explained, “Congress must update parity laws. With the implementation of the Affordable Care Act (ACA), laws related to telehealth, Medicare, and Medicaid only applied at the federal level in certain services.”
Whether to include telehealth services when delivering care is very often determined by individual states. As Dr. Mehrotra said, “This has resulted in Medicare being the big gorilla that drives change and he thinks that parity laws could be in place maybe in a year or two.”
He adds, “Another issue is providing care for unserved, underserved, and minority populations via telehealth. The thinking is that telehealth will decrease disparities in care but this is not always the case. Using telehealth will help but in reality, the greater part of the Medicaid population is most likely to be disabled, younger, and perhaps need more care than the general population. In addition, since their access to broadband may be limited, this population may have less knowledge of new care options.”
An article published by Health Affairs March 2017 www.healthaffairs.org authored by Dr. Mehrotra and other authors titled “Direct-to-Consumer Telehealth May Increase Access to Care but does not Decrease Spending” www.ncbi.nlm.nih.gov/pubmed/28264950, points out how although the use of direct-to-consumer telehealth is growing rapidly, this however, does not always result in a savings for the healthcare system.
Another fact brought up by Dr. Mehrotra relates to the limited provider supply in rural communities which means more care needs to be provided by doctors in urban areas using telehealth. But the problem is that if doctors in urban areas are treating populations in rural areas using telehealth or telemedicine technologies, this can take away from their own patients in urban areas having accessibility to medical care.
As suggested, perhaps this can be remedied by using telehealth more efficiently, perhaps bringing in new providers to treat patients both in the office and via telehealth or by encouraging doctors to work more hours.
Dr. Mehrotra questions, “Even if more people use the system, this would not necessarily produce a savings or improve value in providing healthcare. The most important argument for policy makers is to discuss how the use of telehealth would improve value in healthcare. The thinking is that while increased convenience may be able to meet the demand for healthcare, this use of technology may also increase overall healthcare spending.
Lastly, Dr, Mehrotra concluded by discussing the need to innovate in terms of models of care delivery. The goals are to reduce costs, increase value, and at the same time, create greater access to care. We also need to exam if the use of telehealth and telemedicine to deliver care really improves care in all aspects but also how the use of technology affects and impacts the quality of care.