What would permanent telehealth coverage mean for hospitals? 5 CIOs answer

Many states are relaxing COVID-19 restrictions and dropping public health emergency designations, moves that affect payers' decisions on how to reimburse for telehealth services. Amid these changing policies, many hospitals feel like their telehealth programs are in a state of limbo.

Here, five health system CIOs share what permanent extensions to telehealth coverage would mean for hospitals.

Editor's note: Responses have been edited lightly for clarity and style.

Michael Pfeffer, MD. CIO at Stanford Health Care (Palo Alto, Calif.): More permanent expansion of telehealth would enable hospitals to realize the highest value from leveraging digital interactions to further transform how we deliver care. At Stanford Health Care, we are creating and optimizing telehealth technologies when clinically and strategically appropriate, always with the patient at the center. Hamed Barahimi, our director of inpatient systems, highlights how we enabled remote care for low acuity patients in our emergency department, telepsych emergency department consult services at our community hospital, and virtual inpatient rounding whereby the patient, members of their care team and family can virtually connect seamlessly through our EHR and MyHealth patient portal. 

Aditya Bhasin, our vice president of software, notes that Stanford was a pioneer in telehealth starting with ambulatory video visits in 2015. Reimbursement models limited its expansion until COVID-19, after which video visit volumes increased 15,000 percent with these increased volumes remaining constant even between COVID-19 surges. The new comfort level with telehealth by physicians and patients is allowing healthcare organizations like ours to adopt new operating models with more physician flexibility and more access for patients to engage with their providers based on their preferred modality.

Randy Davis. CIO at CGH Medical Center (Sterling, Ill.): Permanence drives behavior. Institutions find it hard to commit resources to ingrain a workflow into the fabric of their organization when they believe the underlying policies and remuneration realities have all the longevity of a snowflake in April.

For all the talk of value, I still shout out the reality that nearly all compensation is still driven by volume. Physician contracts overwhelmingly are driven by volume. Organizations pay equal attention to reimbursement realities. While not in-vogue to talk about, follow-the-money remains a harsh, though truthful, reality. Telehealth is undoubtedly a valuable addition to the physician-patient relationship. The government is afraid of it due to abuse concerns. Valid. But benefits to our aging populations, many of whom have limited family support options, make a longer-term commitment to telehealth worthwhile. 

The world has moved on from the necessity of face-to-face gatherings — medicine should be at the forefront of making this an option, not the laggards. Physicians want people cared for properly, they and patients will figure out when telehealth makes sense and when it does not. It can't happen without a long-term commitment from the feds (primarily) and commercial payers.

Scott Krodel. CIO at West Tennessee Healthcare (Jackson, Tenn.): It took a pandemic to get the push needed to evolve telehealth within the hospital, physician offices and our patient populations. The payment models have prevented healthcare organizations from doing what is right to serve the patient where they are most comfortable, which is in their home. A permanent expansion of telehealth coverage would allow healthcare organizations to push the care models to another level around virtual care (chronic and wellness) and specialty consultations, as well as increase support of our nation's rural healthcare problems.

As with any new regulation or change in healthcare payment models, it will open the door to a variety of challenges. How do you ensure the patients are getting appropriate medical care if for-profit companies can undercut the system? We have seen many announcements from large non-healthcare companies offering low-cost telehealth visits, but the regulations a healthcare organization must follow are not aligned with these types of companies. Competition is good, but we need controls to ensure patients are getting the best care from qualified physicians.

The expansion is the right thing to do as this is not a technology issue. It is the right thing to do for our patients. However, we need to look at some controls for those organizations that are looking beyond what the patient needs and seeing this as a revenue stream only.

Janice Devine. CIO at Excela Health (Greensburg, Pa.): Telehealth has proven to be a great tool in healthcare's arsenal for taking care of patients, especially during the COVID-19 pandemic when in-person visits were either impossible or discouraged. Telehealth has increased access for vulnerable populations, assisted caregivers and made access to care convenient and efficient. The technology has advanced to support easily accessible video visits with patients. Smartphones, iPads, tablets, and laptops are more commonplace in both the healthcare setting and in patients' homes. 

However, one of the additional significant contributors was the fact that Medicare, Medicaid and many private payers began reimbursing for telehealth visits. In the past, visits of this type were mostly self-pay by the patients and were not reimbursed by the majority of payers. Payers like Medicare treating telemedicine the same as in-person visits has been a game changer and huge contributor to its increase and success. As the public healthcare emergency declaration expires and the waivers for reimbursing for telehealth expire, it will have a significant, negative impact on the use of telehealth and it will decrease, moving healthcare systems back to the in-person model.

James Wellman. CIO at Blanchard Valley Health System (Findlay, Ohio): Permanent telehealth expansion would allow us to continue the positive work we have accomplished and give us another tool to help our patients and families maintain and improve their overall health. CMS exemptions during the pandemic revealed that we can provide safe and effective care remotely, and now we are working to reach a part of the population that was previously challenged in making their appointments and following through on their care. 

There are numerous exemptions that the American Hospital Association recommends to become permanent. Eliminating certain licensure requirements to allow out-of-state providers to perform telehealth services would expand our reach and coverage options. Granting exceptions for practitioners in states that have medical licensing reciprocity requirements to file separate Drug Enforcement Administration registration in any state a provider practices would ensure accurate prescribing and continuity for patients via telehealth services. 

We can use telehealth to overcome normal events in certain parts of the country, like inclement weather, which have allowed providers and patients to maintain their appointments when otherwise they would have to reschedule. A major exemption that supports this scenario is to confirm that providers can perform telehealth services from home or other suitable location and not have to update their Medicare enrollment addresses. Telehealth is now a permanent fixture, and it should be in the future.


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