As the world was hit by COVID-19 which seems here to stay without a vaccine, there has been one question reverberating throughout the healthcare industry: what is the future for the temporary healthcare expansion in Medicare once the coronavirus public health emergency is over?
This is also the same question discussed in the Senate Committee hearing a few weeks ago, “Telehealth: Lessons from the COVID-19 Pandemic.” The Health, Education, Labor and Pensions (HELP) Committee Members listened to four candidates on this topic including Karen Rheuban, M.D From University of Virginia, Joseph Kvedar, M.D from the American Telemedicine Association, Sanjeev Arora, M.D from the University of New Mexico Health Sciences Center and Andrea Willis, M.D. from the BlueCross BlueShield of Tennessee.
These experts had a great deal to say about how telehealth is so important throughout the pandemic and has the ability to truly deliver healthcare in an effective and efficient way before and after the public health emergency. Discussion also touched on how patients showed acceptance of virtual visits and remote patient monitoring. The witnesses also warned how patients are at a risk of losing access to healthcare if the telehealth expansions are not made permanent in future.
Since the PHE was declared, there have been more than 30 temporary federal policy changes that took place related to telehealth. The Center of Connected Health Policy (CCHP) prepared a chart detailing temporary actions taken in reaction to COVID-19, basis of those actions, expiration date and what action could be taken to preserve such policy change after the public health emergency (PHE) is over.
The Senate hearing witnessed great interest in favor of making the telehealth expansion permanent forthe originating sites and to include all locations, including the patient’s house. It was also discussed whether it is a good idea to allow a healthcare provider that’s eligible to bill Medicare for their professional services to maintain that eligibility for telehealth reimbursement – and most people agree. Right now, certain statutes restrict eligible telehealth distant site providers to set list of 8 different providers – physicians, nurse practitioners, psychologists and others.
But since there is a digital divide and lack of technology coupled with digital literacy and access to high speed internet in some low-income communities and areas, concerns were shared and discussed in relation to the possibility of making audio-only telephone reimbursement permanent. BlueCross BlueShield of Tennessee fielded questions about their permanent expansion of parity pay for telehealth delivered primary, specialty and behavioral health care services for all in-network providers.
This hearing was a great start to answer questions and discuss telehealth’s future as many policymakers try to grapple with whether they should approve several telehealth bills that are being presented to congress and are asking to make the current telehealth reimbursement policies permanent in Medicare or in private insurance plans. You can check out the complete list of proposed telehealth bills here including these highlights:
- S 3988 – Amends the Public Health Service Act with respect to telehealth enhancements for emergency response.
- HR 7187 – Provides for permanent payments for telehealth services furnished by federally qualified health centers and rural health clinics under the Medicare program.
- HR 7078 – A study to determine the effects of changes to telehealth under the Medicare and Medicaid programs during the COVID-19 emergency.
- S 3792 – Requires parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth.
- HR 6792/S 3998 – Simplifies payments for telehealth services furnished by federally qualified health centers or rural health clinics under the Medicare program, and for other purposes.
- HR 7233 – Directs the Secretary of Health and Human Services and the Controller General of the United States to conduct studies and prepare a report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children’s Health Insurance programs during the COVID-19 emergency.
- HR 3741: Requires ERISA plans to cover telehealth services at parity for the duration of the PHE.
It cannot be denied that the world has seen a dramatic impact of increased telemedicine because of the Pandemic. Whether or not we can channel that impact to positively change the outlook of healthcare is still a question. Telehealth is a world in its own right and if the pandemic has taught us anything, we know for sure that everything is connected.
Everything is Connected
It is known that people who live in densely populated cities are exposed to air pollution and have a negative impact on their health in the longer run. Covid-19 also alleviated environmental stressors. We know that a healthy environment makes for healthier people. This also illustrated an important aspect of healthcare which is not acknowledged: it does not exist in a bubble. Just as healthcare represents an essential set of services that exist as part of a larger ecosystem, telehealth also represents one type of service that is part of a connectivity ecosystem known as Smart Cities.
Smart Cities use connected devices, lights, sensors, and meters to collect and analyze data that is used to improve infrastructure, essentials services, and public utilities. A report from the McKinsey Global Institute found that smart city technologies can improve key quality-of-life indicators by 30%.
Doctors, Patients and Families Can Stay Connected Remotely and Securely With Hucu
For example, many senior citizens say they would prefer to live the rest of their lives at home rather than move into residential care according to Harvard Joint Center for Housing Studies. But there are gaps in technology right now which makes aging in place riskier. However, imagine an elderly person who lives alone but is being monitored remotely by a wearable sensor that sends out automated data to the healthcare team and alerts them about irregularities that could indicate an underlying condition. Moreover, the patient can use telehealth applications like Hucu to stay connected to his doctor and regularly check-in via video conferencing. In case of an emergency, the sensors can detect if the person falls or is not able to call for help. The device could contact emergency services to send an ambulance. After EMTs determine the patient has to be transported to a healthcare facility, Smart City infrastructure can manage the stoplights on the way to the hospital, give a fast and unimpeded drive to the closest ER with the shortest wait time, and availability of staff to handle the person’s medical needs.
The reality is that today’s telehealth services have only begun to scratch the surface of what is possible in terms of connectivity and healthcare. It is very exciting and has a lot of potential. Though the scenario is fabricated, it is possible that in the near future, we would see something like this being facilitated by telehealth connectivity.
Connectivity Is Everything
To move forward with a true Smart City ecosystem, we need to consider the underlying infrastructure it will take to support it. The biggest factor which can damage the establishment of Smart Cities is a lack of connectivity as discussed in the senate hearing. Without a strong connection between devices, Smart Cities technologies would not be possible to implement.
Smart Cities will be most impactful when they operate across sectors to connect healthcare, public safety, human services, and the environment. Technology can reinvent healthcare as we know it. The pandemic may have been the catalyst for change but hopefully, telehealth’s benefits will inspire more lasting transformation.
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