Payers’ qualms about telehealth put financial onus on physicians

Andis Robeznieks , Senior News Writer

As physician practices and health care organizations wrestle with how to develop the right skill set among their staffs to integrate digital health tools into their work, one expert says one necessary core competency may be getting overlooked.

Protecting telehealth

Comprehensive telehealth reform is critical to the future of health care. The AMA is fighting for legislation to permanently remove restrictions on telehealth coverage and payment.

“Change management is probably No. 1,” said Joseph Kvedar, MD, co-chair of the AMA Digital Medicine Payment Advisory Group, which identifies barriers to digital medicine adoption and proposes comprehensive solutions on coding, payment, coverage and clinical integration.

“For a couple thousand years, all we've done is either visit patients in their homes or they come to us—this is a different ball of wax,” said Dr. Kvedar, who is also immediate past president of the American Telemedicine Association, editor-in-chief of npj Digital Medicine and a professor of dermatology at Harvard Medical School.

“We’ve successfully brought the doctor’s office into the home,” he said during an AMA webinar exploring the “digital health disconnect” that persists despite more than a decade of investment, innovation and clinical adoption.

Patients and physicians have embraced digital health and want its progress to continue, but experts recognize that the nation’s health system hasn’t yet harnessed the full potential of digitally enabled care.

Dr. Kvedar noted that the main issue is that the “demand for health care services outstrips the supply” of physicians and other health professionals. “That is the problem we have to solve,” Dr. Kvedar said.

One thing, however, is clear, he added: “Telehealth is here to stay.”

Related Coverage

Certainty on pay is key to addressing inequities in telehealth

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According to a Rock Health survey cited by Dr. Kvedar, the top health services for which patients prefer a telehealth over in-person care are:

  • Refilling prescriptions—61%.
  • Minor illnesses—51%
  • Mental health treatment—38%.

Payers say they are worried about overuse and fraud. Physicians, meanwhile, are perplexed about payment and administrative complexity.

While the $1.7 trillion omnibus legislation signed by President Joe Biden extended telehealth payment parity and regulatory flexibilities through 2024, there is convoluted variation at the state level, and uncertainty remains regarding payment for audio-only visits. And there are other outdated regulations that haven’t completely gone away.

The extension of pandemic flexibility and payment policies is “good news for everybody,” Dr. Kvedar said. “But two years is a short period for any health care organization to really put a flag in the ground and have an investment strategy.”

Supporting telehealth is an essential component of the AMA Recovery Plan for America’s Physicians.

Telehealth is critical to the future of health care, which is why the AMA continues to aggressively advocate to expand telehealth policy, research and resources to ensure physician practice sustainability and fair payment.

Related Coverage

CPT code set moving at the speed of digital health innovation

The AMA’s telehealth advocacy has focused on removing outdated geographic and originating-site restrictions, ensuring that payments are fair and equitable, and outlining the importance of telehealth in addressing long-standing health inequity, said Zach Hochstetler, the AMA’s director of Current Procedural Terminology (CPT®) editorial and regulatory services.

Hochstetler, who also serves as secretary for the CPT Editorial Panel, listed these key takeaways:

  • Digital medicine services saw sharp growth immediately at the start of the COVD-19 pandemic and have been leveling off, although that leveling is still much higher than what it was before.
  • Digital medicine services, especially telemedicine, play a critical role in health equity.
  • Regulatory and payment challenges remain, but options for reporting services through the CPT code system continue to grow.

The CPT Editorial Panel has moved rapidly, Hochstetler said, to develop coding and taxonomies for telehealth, remote physiological monitoring, remote therapeutic monitoring and augmented intelligence—often called artificial intelligence or AI.

Learn more about how the AMA is driving the future of health.