Dr. Martin Makary and Victor Agbafe: Telehealth access should be expanded after coronavirus emergency

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The coronavirus pandemic has been exposing unnecessary routines in many industries. In health care, the battlefield shift to telehealth is teaching us a lot. After all, does it really make sense to drive to see a doctor for a urinary tract infection, for example, where a hands-on exam may not be required?

Consider our current system of calling to set an appointment, driving and navigating a parking garage, signing in and waiting in a lobby to see a doctor for the 15 minutes it would take just to get a basic prescription? Add to that the expensive medical non-transparent pricing-billing-collections game that drives people crazy.

Of course, an in-person appointment makes sense if you need a hands-on exam, but for many conditions and quick follow-ups, telehealth is far less expensive and reduces the lost productive time for many Americans.

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Due to the COVID-19 crisis, many doctor visits and elective procedures have been postponed as the health care system scrambles to combat the virus. As a temporizing measure, the U.S. Department of Health and Human Services used a waiver to authorize telemedicine expansion for approximately 60 million Medicare beneficiaries.

This governmental action allowed a wide range of clinical providers (physicians, nurse practitioners, physician assistants, nurse anesthetists, clinical psychologists, social workers and dietitians) to see patients via videoconferencing by enabling them to receive the same reimbursements as they do for in-person visits.

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As we empower clinical providers during this national emergency, there is a tremendous opportunity to re-invent the way we routinely deliver health care in the U.S.

Embracing telehealth expands access to medical care and improves our nation’s health security. Never again should we be caught off-guard by a pandemic that exposes our inadequate health technology system for delivering services remotely. Telehealth increases our country’s surge capacity, improves our health security and addresses geographic disparities to high-quality care.

Instituting telehealth widely is badly needed right now. Doctors and hospitals have a massive backlog of patients in a holding pattern for routine and even semi-urgent care. This backlog has received little attention from the media, but it is a tsunami that threatens to overwhelm our hospitals and clinics once the infection subsides.

Currently, existing telehealth platforms are experiencing delays and longer wait times to accommodate the rush of demand. This rush is viewable by the FAIR Health telehealth state tracker. Making robust telehealth systems available to all health care professionals would help us quickly serve the people that have been patiently waiting for their care.

Making telehealth mainstream has the promise of improving quality and lowering costs by ushering in price and quality transparency. 

States can contribute to advancing telehealth by instituting payment parity for telehealth for their state Medicaid programs. Currently, most states reimburse providers for telehealth at a reduced rate, making it challenging for providers to adopt telehealth for their entire practice. This change would impact the health of the 74 million people insured through Medicaid. The benefit is magnified because Medicaid patients have more comorbidities — a major factor accounting for the higher case fatality rate among minority groups in the U.S. 

Medicare and Medicaid patients may represent the most vulnerable populations in the U.S. Creating new lines of health dialogue for these Americans could enable better health promotion and address chronic diseases, which account for 75 percent of health care costs in the U.S. While there are many debates about how to reduce health care costs, one idea has universal support: healthier people cost less.

Private insurers and self-insured businesses can also advance telehealth for approximately 240 million people who do not have government insurance for health care. Twenty-nine states, including those heavily affected by coronavirus such as New York, California and Washington, already require insurance companies to reimburse telemedicine at the same rate as in-person care. Blue Cross Blue Shield of North Carolina, the state’s largest private insurer, is providing reimbursement parity for telemedicine visits.

Health plans have also announced a wider array of telehealth services, and CVS Health has offered its members zero-dollar copay telemedicine health visits for any reason in a 90-day window during the pandemic period. Similarly, some telehealth services, such as Sesame, are allowing physicians to use their telehealth, direct-pay and scheduling platforms for free during COVID-19. While these measures offer help at a time of need, we should consider their benefits long-term. 

The fundamental problem in the health care cost crisis is that markets are not competitive, enabling price inflation fueled by a price markup-discount game between hospitals and insurers. Making telehealth mainstream has the promise of improving quality and lowering costs by ushering in price and quality transparency.

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Times of crisis can provide a long-overdue re-examination of why we do things the way we do. Historically, moments like these have challenged dogma and spawned innovation. For instance, wage controls that came from World War II unintentionally launched health insurance as a worker benefit in the U.S. Given our current strain on our health care system, we need to view telemedicine as a strategic investment to survive not only the current crisis but also the post-COVID-19 recovery. 

Telemedicine payment parity is a means to address some of the most systemic inefficiencies of the U.S. health care system. It’s a straightforward economics argument: if physicians are compensated equally for both in-person and virtual care, they will have a higher incentive to participate, which will increase the supply of physicians on telemedicine platforms. It will also address socioeconomic barriers to better health. Parents will not need to worry about child care and transportation issues to see a doctor.

On the provider end, payment parity will promote competition in the virtual care market and distance is removed as a barrier to treatment, enabling doctors in less populated areas to see patients in the most afflicted areas. Also, in a time of rampant consolidation in the health care industry, telemedicine consults enable physicians to practice in a wider variety of locations (maybe even from home), possibly reducing overhead costs and increasing competition in the market.

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Finally, one of the elusive targets of health care has been quality control. Telehealth allows health care professionals to record their sessions for peer-review, benchmarking and quality improvement. Such an approach can help standardize best practices and elevate the bar for all clinicians. Ultimately, transparent quality information could be used in an open market that competes on value.

It is time we revamp archaic and cumbersome patient services. Doing so has the promise of improving quality and lowering costs by making health care more streamlined and more patient-centered. In order to achieve this goal, all of health care’s stakeholders need to step up to make the current telemedicine experiment a permanent reality.

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Victor C. Agbafe is recent graduate of Harvard University and an incoming medical student. Nancy L. Woo also contributed to this article.