Leading healthcare experts released a report this week outlining major policy recommendations to support the expanded use of telehealth in the wake of the COVID-19 pandemic.
The Taskforce on Telehealth Policy's recommendations include lifting limitations on originating sites, allowing telehealth for various types of conditions and reinstating the Health Insurance Portability and Accountability Act (HIPAA) provisions temporarily lifted during the public health emergency.
The report also recommends that policymakers take steps to expand access to broadband and technology infrastructure to promote equity and not exacerbate care disparities.
As Congress and the Centers for Medicare and Medicaid Services (CMS) work to make certain telehealth waivers permanent, the recommendations from the task force will be looked at closely.
Among the findings from the task force's report is that the unfettered availability of telehealth has not resulted in excess cost or increased use of services, even as supply and demand for in-person care has rebounded.
But the report stopped short of calling for payment parity for virtual care at the same rate as in-person care.
Rather, the task force said telehealth services should be reimbursed "based on a thoughtful consideration of the value provided and the cost of delivery—as is done with in-person care."
"Flexibility on the use and reimbursement of these services is essential to maximizing the benefit to patients and the system at large," the report said.
"Telehealth should be seen as neither inherently driving nor reducing costs," the report authors said. "Similarly, payers should have flexibility in rates and sites, based on different markets and different situations, and should retain the ability to innovate with product offerings that reward value-based providers."
The task force, which was convened by the National Committee for Quality Assurance, the Alliance for Connected Care and the American Telemedicine Association, represented a broad spectrum of stakeholders who spent the summer building consensus among its members on a comprehensive set of findings and recommendations.
The task force assessed early findings and experiences under the flexibilities granted by Congress and CMS during the public health emergency. The recommendations were also informed by more than 300 written public comments and a virtual townhall attended by nearly 1,000 stakeholders.
"This report sets the stage for the clear, decisive action from policymakers," said Krista Drobac, executive director of the Alliance for Connected Care and a member of the task force, in a statement.
"While there is a need for continued data collection and thoughtful regulation, this report demonstrates that both patients and clinicians agree that remote care options should remain available after the public health emergency comes to an end," Drobac said.
However, the American Academy of Family Physicians, which represents about 135,000 physicians, said the recommendations miss the mark and skew toward virtual-only telehealth vendors and large medical systems with established telehealth infrastructure.
The task force's report doesn't address the needs of independent practices that need guidance, support and payment advocacy, wrote Stephanie Quinn, AAFP senior vice president of advocacy, practice advancement and policy in a blog post Tuesday.
"The findings' here turn up almost nothing on how to support the adoption or scale-up of telehealth in smaller practices, a crucial next step for which we've pressed," Quinn wrote.
"If this paper influences decision-making on telehealth, we can expect existing disparities in virtual access to widen, with care becoming more fragmented when we have the chance to make it more cohesive," she said.
Quinn took issue with the task force's recommendation to pilot a "virtual medical home" with a bundled telemedicine reimbursement model, using digital tools to maximize data-sharing and care coordination.
The report advises that the pilot would center on "coordination across care sites provided by community health workers or community-based organizations to ease the burden on clinician and other providers."
That virtual medical home model cuts out primary care providers who are already equipped to deliver virtual care as part of the patient-centered medical home, according to Quinn.
"Outsourcing to retail telehealth providers would undermine the medical home and fracture relationships and care. Instead, the AAFP recommends that telemedicine be thoughtfully incorporated into existing alternative payment models, such as CMS' accountable care organization programs and Primary Care First," Quinn wrote.
Questions around payment and coverage for telehealth services continue to be thorny issues. The National Association of Accountable Care Organizations (NAACOS) supports payment parity between in-person and video-based telehealth to incentivize the use of the technology, according to a letter sent to the task force.
But NAACOS also suggested policymakers revisit payment parity in the future as more data becomes available on the economics of delivering a virtual visit and on utilization.
Accountable care organizations moved quickly to adopt telehealth during the pandemic. More than half of ACOs replaced between 10% and 24% of lost in-person visits with telehealth by early May, the organization said. ACOs continue to deliver between 15% and 30% of their patient visits via telehealth even in areas of the country not experiencing “spikes” in COVID-19 cases.
NAACOS is urging the task force to support granting ACOs more freedom to use telehealth than tradition, fee-for-service healthcare providers.