Before the global pandemic, federal and state regulations around reimbursement and licensure requirements limited the use of telehealth. In the meantime, telehealth initiatives utilizing artificial intelligence and other emerging technologies are providing new strategies for managing costs, creating more consistent medical access, and helping to improve communication between patients and doctors.
On May 6, the Brookings Center for Technology Innovation https://brookings.edu/center-for-technology-innovation and the John Locke Foundation https://johnlocke.org, hosted a webinar to discuss their recently released paper concerning past and forthcoming issues related to the use of telehealth, as well as the state of regulations and how telehealth services should be supported in the future.
The webinar moderated by Nicol Turner Lee, Fellow at Brookings Center for Technology Innovation, introduced FCC Chairman Ajit Pai. He pointed out how the Universal Service Fund administered by the FCC is going to finance a three year Connected Care Pilot program to subsidize internet connectivity for healthcare providers, the FCC recently set up a new grant program with $200 million for the FCC’s Telehealth COVID-19 program, and FCC plans to provide 5G to all parts of the country.
Comments from participants in the webinar included:
- Ross Friedberg,, Chief Legal and Business Affairs Officer, for Doctors on Demand https://doctorondemand.com discussed how barriers need to be relax between states, how regulations are inconsistent across payers, and how different states handle waivers differently
- Dana Lichtenberg MD, Assistant Director, Congressional Affairs, AMA https://ama-assn.org wants to see Congress stop treating telehealth differently and does not want restrictions on the use of telehealth. She sees how telehealth has previously been underpaid but the reality is that the use of telehealth isn’t always less costly.
- Jordan Roberts MD, Health Policy Analyst, John Locke Foundation, addressed state parity laws. Reimbursement for medical treatment need to be the same for a virtual visit as an in person visit
The Brookings Institution paper Removing Regulatory Barriers to Telehealth Before and After COVID-19, authored by Nicol Turner Lee, Jack Karsten, and Jordan Roberts with research support provided by Shezaz Hannan, Bhaargavi Ashok, and Lia Newman, reports that state and federal barriers related to telehealth have serve as hindrances to developing telehealth’s full capabilities.
In general, the barriers to telehealth adoption concerns cost and reimbursement policies, licensure, equipment issues, incompatible EHRs, and gaps in rural broadband. Also, there are disparities especially in areas with low income populations making it difficult for many to access telehealth services.
The paper points out that generally, federal laws have been either permissive or dismissive of telehealth provisions but also how no two states have the same regulations when it comes to coverage and payment. This has resulted in the diffusion of telehealth services where large states can offer services over a larger area than a doctor in a smaller state.
The paper makes several recommendations:
- Data on COVID-19 administration and programs must be collected and analyzed
- Regulatory flexibility should be built into telehealth to accommodate the range of use cases
- Telehealth services should be used for primary care to reduce service redundancies
- States should be empowered to move away from parity models to reduce the cost of telehealth services
- Telehealth services should be available to all people in medically underserved areas
- Innovation, privacy, and data security in telehealth services should be the normal
The paper reports that while progress was made before the coronavirus outbreak to adopt telehealth in states, the pandemic proved it very necessary to use telehealth to avert larger meltdowns in hospital systems.
The paper concludes by pointing out, Congress will need to re-evaluate the leniencies permitted to healthcare providers during this crisis but also look at the benefits. States will also need to reconsider lifting boundaries on telehealth services in order to accelerate the transformational capabilities for telehealth when used for patients by doctors.
Go to https://www.brookings.edu/research/removing-regulatory-barriers-to-telehealth-before-and-after covid-19 for the paper Removing Regulatory Barriers to Telehealth Before and After COVID-19, a collaboration between the Brookings Institution’s Governance Studies program and the John Locke Foundation.