The past, present and future of telehealth

The Public Health Emergency (PHE) is set to end in May, and with this comes the pressing question from all sectors of healthcare, What about telehealth?

The waivers enacted during the PHE boosted telehealth usage. Now that the Biden administration has decided to discontinue the PHE will those valuable telehealth waivers fall away? It's been said that the best way to predict the future is to study the past, so let's have a look at how far telehealth has come and see if we can foresee its future.

Prior to the beginning of the pandemic, the bulk of telehealth regulation was handled at the state level, and no two states approach it exactly the same way. Medicare only reimbursed for telehealth if the patient lived in a rural area and was physically in a Medicare provider’s office during the virtual consultation with a remote specialist.

Pre-pandemic state policies differed on:

• Which telehealth modalities were acceptable (asynchronous vs synchronous)
• Which medical professions were permitted to provide telehealth services and under what circumstances
• How new patient-provider relationships were established
• If and how medications could be prescribed
• Whether out-of-state practitioners could treat patients without holding a full in-state license
• How non-federal insurers reimburse telehealth

The formal public health emergency triggered by the pandemic enabled the relaxation or modification of many telehealth regulations. The federal government made the following changes, among others:

• Allowing coverage and reimbursement of Medicare telehealth services regardless of the patient’s location
• Allowing Federally Qualified Health Centers and Rural Health Clinics to be reimbursed for telehealth services
• Waiving the requirement that a physician sees a patient in person before using telehealth for the remote prescribing of a controlled substance
• Allowing hospitals to provide telehealth services from other sites
• Permitting telehealth to be designated as an “excepted benefit” allows more employees to receive telehealth through their employers.
• Licensure waivers increased the number of providers allowed to deliver care across state lines.

The use of telehealth soared during the pandemic and demonstrated its value in improving the delivery of and access to health care. More than 80% of physicians believe that patients have better access to care since using telehealth while 94% of patients want to continue to have access to telehealth in the future.

The American Telemedicine Association believes that the American government will continue to support telehealth after the PHE. Unfortunately, flexibilities allowing for remote prescribing of controlled substances currently expire with the PHE.?

The ATA proposes five priorities that should serve as guides for crafting new telehealth regulations post-pandemic:

1. Licensing barriers that keep providers from working across state lines or nationally should be removed
2. Access to telehealth shouldn’t depend on patients’ physical location, their access to a specific type of technology or the quality of their communications infrastructure
3. Value-based reimbursement of telehealth?
4. The reimbursement of care provided to underserved communities through telehealth?
5. Leveraging telehealth for remote patient monitoring

It's hard to see what the future may hold for telehealth. Providers and patients alike must hold their breath while regulators decide telehealth's fate.

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