Is telehealth over before it began? Let’s hope not.
First, there is the clinical aspect. While telehealth was vital during the pandemic, it is unclear to what degree telehealth can fully substitute for in-person care (see Hatef et al. 2022). Likely telehealth is superior to in-person visits for some types of care, inferior for others, and reasonable substitute for many. It will require time to identify for which conditions, patient types, and physician types is telehealth most useful.
Additionally, payers have concerns about how the use of telehealth will impact their bottom line. CBO projected that added telehealth flexibility would cost the federal government $333 million in 2023. The Committee for a Responsible Federal Budget (CRFB) wrote last week that:
Since telehealth’s entrance into the health care market, overall recoveries in health care fraud have doubled from $2.6 billion in FY 2019 to over $5 billion in FY 2021.
According to the American Bar Association, potential problems include up-coding time and complexity; misrepresenting the virtual services being provided; billing for services not rendered; and kickback schemes that spread profit from unnecessary tests, medications, and equipment.
In part due to clinical and economic concerns, some payers are reducing the generosity of payments for telehealth, moving telehealth payment to a level far less than parity. Larkin et al. (2022) writes in a JAMA perspective today that:
Coverage limits make it harder for physicians to offer telehealth services that could benefit patients. For example, about 6 months ago a major commercial payer in Pennsylvania cut telehealth payments to 85% of in-person fees, making it difficult to break even on them, retired pediatrician and clinical informatics specialist Susan J. Kressly, MD, said in an interview.
As a result, the 4-physician pediatric practice she cofounded in Warrington, Pennsylvania, has cut telehealth to about 5% of visits,
In the latest COVID-19 primary care tracking survey by the Larry A. Green Center in Virginia, 28% of 847 respondents in 49 states and the District of Columbia reported they have limited their use of telehealth, both audio and video, due to insufficient payment.
It’s a particular problem with private payers and smaller practices, Green Center Codirector Rebecca S. Etz, PhD, said in an interview. “Payment has been an issue since the beginning. For phone visits some said they get as little as $3. For video it’s as little as $17,” Etz said.
While there are genuine clinical and economic concerns surrounding telehealth, the COVID-19 pandemic showed that telehealth technologies can improve care and increase efficiencies. The question now is not whether or not providers should use telehealth (they should) and whether payers should pay for telehealth (they should), but in what situations is telehealth most helpful to patients and how can we reimburse providers to encourage the use of telehealth while allowing payers to capture a portion of any cost savings providers create using telehealth.