COVID-19’s Impact on Telehealth Policy Now & In the Future

Telehealth policy is rapidly changing. Catch up on recent developments and find out what regulations to watch for as telehealth takes center stage.

Our own Chief Strategy & Compliance Officer and Wheel Co-founder Griffin Mulcahey recently joined a webinar panel discussing the impacts of the COVID-19 pandemic on telehealth policy today and what the outlook for the future holds. The panel was hosted by healthcare research and advocacy group Farragut Square, and Griffin was joined by the president of the American Telemedicine Association, Dr. Joseph Kvedar, and Partner of the Digital Health Practice at McDermott, Will, & Emery, Lisa Mazur.

Panelists spoke about how telehealth adoption has changed the regulatory landscape, healthcare specialties particularly suited for telehealth, important recent policy changes, and what’s needed for long-term telehealth growth.

Here are five themes that emerged from this critical conversation.

Telehealth utilization has leveled out at a sustainable, healthy, and expected plateau.

It’s clear that the coronavirus pandemic skyrocketed telehealth adoption by both clinicians and patients, but what’s been unclear is at what level utilization would sustain. “While there is no such thing as an overnight sensation, we’ve been laying the pipe for this for several years,” said Dr. Joseph Kvedar, president of the American Telemedicine Association.

COVID-19 forced healthcare providers to rapidly adopt virtual care technology that was on a 5-year roadmap for expected widespread use. Even reluctant specialties like orthopedics realized how and when to apply telehealth services in beneficial ways. But telehealth is not a one-size-fits-all service, and the specific utilization mix for each healthcare specialty is still to be determined.

Kvedar says that while clinician adoption approached 80-90% in April and May, rates have now plateaued at about 20-40% within ambulatory care. With CMS’ lead administrator vocally supporting continued reimbursement for telehealth services post-pandemic and surveys showing Medicare patient satisfaction with telehealth services above 90%, the panelists agree that COVID-19 is indeed a major inflection point—and we can count on these utilization rates in the future.

“The idea that 30% of my job becomes telehealth going forward is quite likely and quite palatable.”
- Joseph Kvedar, MD; President American Telemedicine Association; Dermatologist, Massachusetts General Hospital; Co-chair AMA Digital Reimbursement Committee; Editor-in-Chief of npj Digital Medicine

“There is going to continue to be patient and consumer demand for telehealth, and that is going to encourage the momentum with private payers, Medicare, and Medicaid opening the doors to coverage and reimbursement. There’s a comfort with it [telemedicine] that just never existed before—and that will continue.” -Lisa Mazur, Partner, Digital Health Practice at McDermott Will & Emery

Trusted, traditional healthcare brands are driving the adoption curve among laggard crowds.

Telehealth is now a household word, but exactly what happened during the pandemic to get us here? Griffin Mulcahey of Wheel says it’s been telehealth implementation by trusted community brands like CVS, Walgreens, and your local medical groups that have really moved the needle among older or laggard crowds.

“At the end of the day, a lot of consumers still want their doctor group, that trusted logo. Traditional healthcare brands in everyone’s community have adopted the technology being driven forward by more tech-focused enterprises, and that’s changed the types of patients adopting it [telehealth].”
- Griffin Mulcahey, Chief Strategy and Compliance Officer & Co-founder at Wheel

ZocDoc is another example of a service that consumers were used to using for booking in-person appointments. During the pandemic, ZocDoc added virtual care appointments, but even as people go back to booking regular brick and mortar visits the company is seeing virtual care bookings remain strong.

That’s been the biggest change in virtual care evolution, traditional brands adopting telehealth and bringing in the older or laggard crowd that may not have tried the Roman’s of the world as an entry into telemedicine.

Utilization data from COVID-19 should inform additions to the list of qualified telehealth services.

There is a spectrum of virtual care applicability across specialties, and patients and doctors must find the right balance of activities that hits three fundamental healthcare issues: convenience, quality, and access.

“If you can make a diagnostic decision or a care plan decision without touching the patient, telehealth is fair game.”
- Joseph Kvedar, MD

However, sometimes it’s hard to discern what services can be completed through a digital health consult without the risk of duplicative experiences. For example, dermatologists can assess a variety of skin conditions through telehealth, but some patients may still need an office visit to complete a biopsy—inconvenient for the patient and expensive to the payer because of duplicate claims.

So far, a few specialties and services have shown to be particularly well-suited for telehealth:

• Mental health
• Urgent care
• Follow-up visits
• Pediatrics
• Chronic care management
• Hospital specialty care
• ICU specialists

Ultimately, analysis of telehealth utilization data should help policymakers make more informed decisions about how telehealth should be used going forward.

There have been dozens of potentially permanent and meaningful changes to very long-standing telehealth regulations.

Numerous flexibilities have been enacted at both the government and private levels that have made a meaningful difference in care, but there are still some outstanding questions.

Medicare

• Temporary removal of originating site and geography restrictions that prevented Medicare recipients from receiving services in their homes
• Expanded list of covered telehealth services
• Expanded types of qualified healthcare providers that can render telehealth services
• Proposed fee schedule for 2021 with significant changes, nine new codes added, and many temporary codes included
• Direct supervision restriction changes with the ability for physicians to leverage other types of healthcare professionals into remotely supervised and incident-to billing

Medicaid

• Expanded list of covered telehealth services: Medicaid typically leads Medicare in terms of coverage and reimbursement and they recently took a big step forward. For example, kids are getting telehealth access to important services like occupational therapy, physical therapy, and speech therapy.

Private payers

• Changes to state coverage parity laws and payment parity laws: The effectiveness of these laws has varied widely. In Illinois, for example, more payers are covering telehealth and it’s made a significant difference in access.

Executive orders

• Expanding telehealth services for Medicare recipients
• Waivers for professional licensure requirements

Many industry leaders agree that true telehealth expansion must come from the top down through congressional changes. But even executive orders have left open questions about how to interpret new policies. Wheel’s Griffin Mulcahey says that success will depend on private payers continuing to reimburse services, as that drives behavior. And moving forward, we need to ensure more healthcare services like physical therapy, occupational therapy, and addiction and substance abuse treatment are covered.

We need a uniform regulatory structure and congressional action to protect clinicians and reveal telehealth’s true impact.

From liability protections to holistic regulations, congress has work to do to propel telehealth to its full potential.

Many healthcare providers worry about liability and false claim liability for telehealth due to confusing regulatory nuances and near-constant changes in state telehealth declarations. That’s making many clinicians pull back their telehealth services.

“Physicians need to make a living and operate a business and they are operating under extreme uncertainty. Until congress starts permanent changes to fee schedules, not temporary, not executive orders with end dates, telehealth’s real impact won’t be realized.”
- Griffin Mulcahey

In addition, Dr. Kvedar says the ATA is focused on overturning the originating site rule, an arcane Medicare law that limits telehealth access. “You should be able to receive these services from your home whether you are in downtown Detroit or rural Montana—it shouldn’t matter.”

While there are lots of exciting initiatives underway, there are also lots of voices and requests being thrown at Congress.

“Sorting through what the most important issues are is an important first step [for Congress].”
- Lisa Mazur

Visit McDermott, Will & Emery’s coronavirus resource center to learn more about COVID-19 and the impacts on telehealth from recent digital health policy changes. Read more about Wheel's COVID-19 Telehealth Emergency Response Services here.

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