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Removing barriers to telehealth for patients and physicians can help broaden access to care and help this technology reach its full potential. American Medical Association Board of Trustee Member Alexander Ding, MD, MS, MBA, joins to discuss the efforts the AMA is taking and where the future of telemedicine is headed. AMA Chief Experience Officer Todd Unger hosts.
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- Alexander Ding, MD, MS, MBA, board member, AMA Board of Trustees
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about some of the ongoing barriers that physicians and their patients are experiencing with telehealth and what the AMA is doing to address them.
Joining me today is AMA Board of Trustee member Dr. Alexander Ding in Louisville, Kentucky. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Ding, we're glad to have you today. Welcome.
Dr. Ding: Thanks so much for having me on, Todd. It's great to be with you again. Really appreciate the opportunity to join you today to talk about telehealth.
Unger: Well, telehealth is something certainly that we've seen change dramatically over the past few years. We saw quick and widespread adoption of telehealth driven by the pandemic. Let's talk about first, what are some of the challenges that it prevented patients from taking full advantage of it?
Dr. Ding: Yeah, well, telehealth really took off during the pandemic for both doctors and their patients as they recognized what an important medium this technology serves to keeping them connected when physical interactions were not possible. Doctors and patients learned through the pandemic that keeping these connections, even virtually, were important to continuing to keep lines of communication open and to continue that critical trust building in the patient-doctor relationship that is built on multiple points of continued interaction. And virtual is a perfectly acceptable way for the maintenance and building of this relationship.
Unfortunately, during the pandemic, the disparities in this country became even more apparent and were accelerated. We saw this with health disparities and other social drivers of health not being supported, further driving these health inequities. So one of these areas we don't talk about a lot are the technological inequities, which end up being additional drivers of health, including lack of access to technology, including computers, smartphones and another critical component of telehealth enablement, which is broadband, internet access, or high-speed cellular service. This, in conjunction with limited technological and digital literacy really, limits the opportunities for access to telehealth to a large subsegment of the population that is historically marginalized and/or underserved.
Unger: Now, supporting telehealth is one of the five priorities within the AMA's Recovery Plan for America's Physicians. And the AMA has been working to remove obstacles with telehealth for years. At our most recent annual meeting, we passed another new policy on telehealth. Can you give our audience out there some background on what that new policy is calling for?
Dr. Ding: Yeah, thanks, Todd. The work that the AMA has been doing in advancing the Recovery Plan for America's Physicians is absolutely critical. It contains a number of critical items, including reducing physician burnout, reforming the inadequate Medicare financing system and also contains as a primary pillar supporting telehealth for improving access to care for doctors and their patients.
Post-pandemic, we've heard from doctors and patients that they think telehealth is an important means of getting access to care. Nearly 70% of physicians that the AMA surveyed said that they wanted to keep providing telehealth services post-pandemic. However, many of the pandemic-age policies that supported the use of telehealth are set to expire or go away now that the public health emergency has officially ended.
That all having been said, you're referring to a new policy that the House of Delegates passed just last month. The crux of that policy is that the AMA will work with policy makers to educate and teach patients about the value of telehealth and how to best access and use telehealth to best maximize the benefits. And, ultimately, what we really care about is, how does this technology and tool help us improve health outcomes?
Unger: Dr. Ding, do you have kind of specific asks or efforts that we'd like to see from policy makers.
Dr. Ding: Yes, part of the AMA's Recovery Plan for America's Physicians, we are seeking policy makers to take those learnings that we learned from telehealth, which includes increased remote access, expanded access. We've seen increased patient satisfaction, all while maintaining quality and safety of care.
These are all things that we learned from telehealth during the pandemic. And we would really like to enshrine these policies to allow those flexibilities, to practice in those ways with telehealth, and to make those policies permanent rather than expiring with a public health emergency. Additionally, this newer policy that we refer to as seeking public resources to help aid patients in the American population, particularly those that tend to have bigger challenges to accessing and using technologies.
This can take on many forms, including greater access to broadband or subsidized internet access for underserved areas, such as those areas with physician shortages. This can also take on the form of resources to fund digital literacy efforts to help our seniors, patients with disabilities, patients with complex medical conditions and other minoritized populations really better understand how to engage with and utilize technology for health access, including support services that may further provide technical guidance and support.
Oftentimes we saw doctor's offices—we see doctor's offices spend a great deal of resources and time to help with the technical support aspects of telehealth access. And given the already limited bandwidth of our health care provider teams, we're seeking additional resources to help those challenged with digital literacy to get additional help and support because accessing telehealth remains an important means of access to care.
Unger: I don't think we need to add tech support to the ever-growing list of things that we need physicians to be doing on top of everything else. And it's interesting because we've talked a lot about the obstacles that patients are encountering, including some of the implications of that in terms of equity. But let's talk more specifically about physicians. You brought up one of the challenges there. What are some of the other changes that need to happen for physicians to take full advantage of telehealth?
Dr. Ding: Yeah, I would say first and foremost is that payers, both private and public, need to recognize the value and the importance of telehealth as a way for doctors to better care for their patients. And that access to such services and technologies is an important component of the future of clinical care. And so as such, we need to make sure that insurance plans provide coverage for telehealth services.
Secondly, given that this practice is still in relatively early stages, especially some of the newer telehealth technologies, like remote patient monitoring and digital health, best practices are starting to emerge to help physicians understand how to structure clinical models and determine when is the right time to use telehealth, including what are the appropriate indications, who the right patient population is to engage with these platforms, what are the best ways to structure workflow and how do we make sure that safety and quality are maintained in virtual interactions.
Now, on the issue of coverage, the AMA did win an important victory with the passage of legislation extending pandemic related telehealth flexibilities through 2024, ensuring that patients can continue to receive remote care regardless of where they lived. Now we are now working with Congress and the Department of Health and Human Services to making these changes permanent.
Unger: And the extension of those telehealth flexibilities—that's a big accomplishment from the AMA. Any other kind of efforts from the AMA that you want to highlight?
Dr. Ding: Yeah, in addition to advocating for these telehealth flexibilities both in policy, coverage, and reimbursement to ensuring access, the AMA has been working to help physicians understand best practices with telehealth and doing what we can to help disseminate this information. So to advance physician adoption of telehealth, the AMA co-founded the Telehealth Initiative in collaboration with the Physicians Foundation and state medical societies in Florida, Texas and Massachusetts to aid physicians in those states to redesigning their practices to successfully integrate telehealth services.
And at the same time, the AMA has created a number of free online resources for physicians to help them better understand telehealth and how to integrate them into their practices. So this includes the AMA's Digital Health Implementation Playbook series, which offers a comprehensive step-by-step guide to implementing digital health solutions in practice based on insights from across the medical community. Our vision really is that physicians have the tools, the resources, and the support to seamlessly integrate telehealth into their practices without financial risk or penalty and that patients have the opportunity to access telehealth services from the comfort and privacy of their homes, wherever they might live.
Unger: Well, let's look to the future a little bit, thinking about the future of telehealth. You have a pretty interesting view there because you're also an advisor to a venture fund that's focused on investing in the next generation of health care companies. When you think specifically about telehealth, what innovations do you hope or expect to see over the next few years?
Dr. Ding: Yeah, that's right. But I think my answer is probably going to be a little bit different than what you might have expected. You probably thought I was going to say something about the next generation of technology, like remote patient monitoring, connected health, digital health or AI.
And whereas all of these technologies have the potential to be very interesting and exciting, I'm actually most optimistic about how these technologies and care model innovations can bring together doctors and patients to truly improve that key patient-doctor relationship and how that relationship really can be leveraged as a therapeutic relationship to improving the health of this country. So what I mean by that is I see technology as a tool. It itself is not a means to providing care, empathy, improving health. What it does is enables our physicians and other health care professionals to best care for patients and populations.
And so as we've seen in prior iterations, technology that's been imposed on health systems and doctors, like EHRs, quite frankly, they've ended up as being contributors to obstacles to practicing and drivers of burnout. And so when I'm looking at innovative companies, I do it through the lens of, how does this technology help doctors and patients? How is it seamlessly integrated into existing workflows? And what's the data behind whether or not it truly improves outcomes?
And so what I'm really looking forward to is how new innovations in care, technology, finance models, things like value-based care can really leverage these new technologies to more closely bring together physicians and care teams with patients and their families to best optimize health, leading to better engagement, stronger therapeutic relationships, more closely managed chronic disease and better predictive insights that allow us to truly transform health care system from being a reactive one. One that focuses on acute episodes of care, and treating sickness into one that is truly innovative and, honestly, transformational, which is a health care system that manages and optimizes health and prevents and minimizes the burden of illness rather than just reacting to acute illness. And I think technology has a role in enabling that.
Unger: Well, that is something that we will definitely look forward to. Dr. Ding, what a pleasure to have you. Just such great perspective.
That's it for today's episode. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.