Will virtual-first healthcare become a reality under the Biden administration? Wheel President and Co-Founder Griffin Mulcahey discusses the policy changes needed to remove long-standing barriers to digital health advancement.
The Biden administration’s immediate healthcare policy priority will be squarely focused on meeting his promise to deliver 100 million vaccines in his first 100 days — spending much of his political capital on passing the $1.9 trillion relief plan and taking a 180-degree turn on vaccine delivery.
With more than 400,000 COVID-related deaths and new variants of the virus emerging, the need to expand access to care and coverage has never been more pressing. While revisiting the Affordable Care Act likely remains on the top of Biden’s priority list, any reform will be far down the road recognizing the Democrats’ slim majority in Congress — and the public option is almost certainly off the table.
The potential solution to this immense challenge is something we’ve been moving towards since last year — a virtual-first approach to healthcare, which could offer an immediate stop-gap to our public health emergency as well as a long-term anecdote to a healthcare system that is on the brink of collapse.
Yet the question remains whether the digital front door will ever be supported by a permanent policy infrastructure.
Here are three significant changes the administration needs to address.
Policy 1: Rework our payment models
Personally, I don’t blame payers for throwing their weight against payment parity for telehealth consultations.
If our argument is that virtual care improves patient outcomes while driving down costs, we shouldn’t expect a remote exam to be reimbursed at the same rate as an in-person exam.
Instead, we need to combat the tendency to bring a broken system online and push forward new payment models that more accurately reflect the cost to deliver care.
What the digital health industry does finally have on our side is a year’s worth of data of telehealth at scale. A tiered pricing model informed by this data could help to ensure providers are reimbursed, payers don’t balk, and cost savings are passed down to patients.
Policy 2: Address licensing barriers
While the national emergency declaration in March of 2020 made headlines implying the removal of state license barriers, the practical truth is state law still governs whether a clinician can practice state to state.
40+ states did enact emergency declarations, but those state level waivers were confusing to navigate, limited in scope, and many were time sensitive and have already expired. State licensing, and state-level differences in clinician scope of practice for nurse practitioners and physician assistants, remains one of the most significant barriers for clinicians to reach more patients and I’m not overly optimistic this hurdle will be addressed in the near future.
The private sector may need to continue stepping in to support clinicians and help them navigate through the red tape for the foreseeable future.
Policy 3: Navigate patient data sharing
The good news in the short term is that the pandemic continues to usher in practical policy making.
HHS has extended its emergency waiver of HIPAA sanctions and penalties for telehealth, and HHS announced it will not impose HIPAA penalties for the use of online scheduling software for vaccine appointments.
Long term, interoperability will continue to be a primary focus on the policy front, especially now that healthcare organizations are acknowledging that the patient experience will continue to move online, leading to potentially more fragmentation.
While there are favorable changes to HIPAA currently on the table, the boom in the digital health space may create a counter-balance effect with a new wave of regulation at the state level. With a small step forward and likely a few steps back, we’ll continue to face an uphill battle on the policy front to make patient data easily shareable.
What happens now
Politics aside, the Trump administration enabled several years of virtual care adoption and recognition at the policy level in just a few months. It remains to be seen what the weather looks like for digital health advocates under a Biden administration, especially when considering the immediate needs at hand. We’ll continue to voice the potential behind a virtual-first healthcare model, but we will likely need to brace for a continued period of uncertainty and temporary waivers.
Griffin Mulcahey, Wheel President & Co-founder
Did you know that Wheel was co-founded by an expert in healthcare law? We take regulatory issues very seriously and provide our clients with virtual care compliance solutions that help untangle the federal and state-by-state telehealth delivery laws.
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