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Sunday, September 20, 2020

Congress has a chance to get telehealth right

COVID-19 and the emphasis on social distancing has highlighted the many benefits of telehealth. Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander recently called for legislative action to make flexibility for telehealth permanent. As Congress moves on this topic, special interests will mobilize to add mandates that require higher prices for all telehealth services. For people with disabilities, those with chronic conditions, and lower-middle-class patients, telehealth is a literal lifeline to their doctors, yet mandates can adversely affect them. Policymakers should reject these mandates but still adopt a robust framework for providers to use telehealth without barriers for care across state lines.

Telehealth saves enormous amounts of time and avoids time spent in a waiting room with other sick patients. It is more convenient for the provider and can be delivered from almost anywhere. The convenience of this care is a key indicator why telehealth can and should be delivered for a fraction of the cost of an in-person visit.

Yet, some are pushing mandates called payment and coverage parity, which ultimately makes telehealth more expensive and pushes care out of reach for vulnerable patients. The mandates force patients to pay the same rate as if they had visited the office in person, and for older adults on Medicare, patients and taxpayers will have to pay more as well, including all extra fees and administrative surcharges that would otherwise be avoided when using telehealth. This seems to be behind the thoughtful calls by Centers For Medicare and Medicaid Administrator Seema Verma to reexamine the government paying higher rates for telehealth.

Telehealth can be a game-changer for post-stroke care and for treatments for physically disabling and treatment-intensive conditions. Yet, for other services, the evidence of better outcomes is far less certain. Insurers, employers, and public programs should have a choice in what they cover and not be mandated to cover all services even if some return little to no value.

Wasteful spending is estimated to be about 25% of current healthcare spending, or up to $935 billion a year. Many of the sources of wasteful spending could be abused with the convenience of telehealth, especially if those paying the bills are mandated to write a blank check for such services.

States that have telehealth mandates have seen huge spikes in use. That may sound like a good thing at first, but these mandates often force patients to pay these higher rates, and as spending increases due to ease of use, vulnerable patients are left with less money for gas and groceries and higher insurance premiums the next year.

These mandates also mean that huge health systems demand inflated prices, even though their services are not always higher quality. No one thinks what we need is more expensive healthcare, yet these mandates mean that we take a more efficient way to deliver care and jack up the price from what it could cost.

Finally, these mandates will slow innovation as most new telehealth services are being paid for by each appointment, which means that new patient-centered care models such as team-based care will not happen because payers will be mandated to pay just one way.

The telehealth revolution should change the face of healthcare to be more patient-focused, to be less costly, and to help us organically evolve away from our out-of-date, costly systems for routine care. If Congress mandates a telehealth framework that includes coverage and payment parity, we will have an environment that will fuel increased utilization for all services that will carry a higher cost, with many not delivering better outcomes. Ten years from now, we will be looking back wondering why spending has gone up yet again without a universal benefit being realized for patients.

To do this right, Congress should adopt a telehealth and telemedicine framework that allows providers of all kinds to utilize these services and allows easy access across state lines without any mandates.

Josh Archambault is a senior fellow at the Foundation for Government Accountability.

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