Health

We have little time to protect access to telehealth

The U.S. health care system often moves at an icy pace, but COVID-19 has catapulted it into the future with an instant acceleration of telemedicine as a treatment option.

During the first four months of the pandemic, telehealth accounted for 23.6% of all visits to the doctor, up from nearly zero a year earlier. But while experts predict that virtual aid isn’t going anywhere, the legal emergency that enabled it is starting to expire. We now have to figure out how to keep telehealth before time is up.

We know that telehealth increases the interaction between patients and their doctors. As the pandemic weakens, personal doctor visits are returning to pre-pandemic norms, while telehealth remains strong. At Mount Sinai Healthcare, we average over 42,000 visits per month in 2021, many times our pre-pandemic annual rates.

The dramatic change in volumes shows how telehealth has opened up new opportunities for patient access. Working families, communities of color, undocumented immigrants, uninsured, and others have long struggled to get standard model assistance due to transportation, childcare, work schedules, costs, and more. Remote communication with doctors can alleviate these problems by creating flexibility for patients, allowing them to receive care without having to negotiate logistics, potentially improving health outcomes.

But one obstacle to the development of telehealth is that during the pandemic, health officials at the federal, state and city levels took many measures to expand telehealth that were meant to be temporary. If the measures that allowed telemedicine to thrive eventually expire, patients who have come to rely on telehealth as a reliable and convenient way to stay healthy will lose out.

For example, the state-based medicine licensing model has traditionally limited telehealth, so telehealth can only be provided in the state where the patient is currently living. But during the pandemic, interstate cooperation agreements allowed patients living across the country to receive the care of their resident physician through telemedicine. If the old licensing system returns, a patient in New Jersey may be barred from scheduling a telemedicine visit to a Manhattan physician because his physician may not be licensed in New Jersey.

Health economists might argue that an increase in the total number of doctor visits will unnecessarily increase the use of medical services, leading to an increase in overall costs. But there is a way forward that keeps costs down.

First, we can focus on providing more telehealth privileges to the health care systems that use it, as part of their commitment to maintaining patient health through preventive measures. In these cost-based service schemes, insurers commit to reward hospitals and doctors whose patients continue to be healthy, not those who recruit the most (expensive and potentially unnecessary) tests and procedures.

Telehealth is a natural fit for this incentive model. This allows doctors to regularly contact their patients at less cost or inconvenience to them or their patients, and as a result, keep patients healthier. By prioritizing patient health, no matter how we meet patient care needs, we can help manage conditions in our patient groups and improve quality of life so that patients receive and stay healthier.

Another important step is linking telehealth to innovative care delivery methods so that communities receive the care they need. We have started a program of working with local health workers at AIRnyc, who provide telemedicine visits for physical, behavioral and social assistance. Patients from low-income families referred to AIRnyc are less likely to receive technology-based home health care. But in partnership with a local health professional, we have proven that many obstacles can be overcome. Through clever program design and investment, there are ways to improve care even without technical skill or access.

We must also adapt the ongoing implementation of telehealth to a public health approach. One of the significant disadvantages of telehealth is that many vulnerable patients still cannot access the technology and Internet access needed to ensure the reliability of telehealth. The federal government must use telehealth as a motivation to finally secure real and sustainable investments in the infrastructure that makes telehealth possible, starting with universal broadband and Wi-Fi. The Internet is no longer a commodity; it is an important tool for health and economic development. We need the federal government to activate and guarantee universal Wi-Fi for everyone.

Finally, and most importantly, we need the federal government to work with state licensing boards to continually expand the benefits set during the pandemic that make telehealth more flexible.

Creating a permanent place for telemedicine in our health care system not only improves the health of the population, but also improves the economy of health care delivery in general. It will cost less to provide care to patients and put less strain on the health care system. It’s time to take all the lessons from this pandemic to move our healthcare system into the future.


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