This opinion piece is a response to the recent article from mHealth Intelligence, “Will Telehealth Payment Parity Be Permanent or a Passing Fancy?” The February 22, 2021 article by Eric Wicklund discusses telehealth stopgap insurance coverages during the pandemic, and how coverage may change as providers continue to leverage telehealth in the new normal. Wicklund’s investigation of payment parity is shaped around a recent study by Foley & Lardner on telehealth coverage and state-level parity laws.
The pandemic and subsequent telehealth surge impacted healthcare coverage almost immediately. Many restrictions were waived, payment parity increased, and requirements were often bent to allow for stopgap solutions to the pressing issues COVID created for patients and providers.
“The Foley & Lardner study shows that payment parity did increase during the past two years. In all, 22 states now have laws that specifically address telehealth reimbursement, up from 16 in 2019, and 14 states now mandate true payment parity, up from 10 two years ago.”
“Will Telehealth Payment Parity Be Permanent or a Passing Fancy?”
While studies show that telehealth can be a cost-effective, timely, and safer care option in many instances, the reality is that without parity provisions, providers aren’t incentivized to support telehealth consultations. Unfortunately, insurance coverage dictates the services made available, which can mean deference to in-person care even when an individual patient could more easily afford out-of-pocket virtual visit costs. Patients with chronic illnesses, for example, may not always require hands-on care, but may still frequent the hospital when virtual care is not covered.
“If that clinician is not guaranteed payment because the patient’s insurer doesn’t cover telehealth – or even if the private payer pays substantially less solely because the visit is virtual – then that clinician is less likely to offer telehealth to their patients.”
Sarah Iacomini, Associate, Foley & Lardner
“Will Telehealth Payment Parity Be Permanent or a Passing Fancy?”
Telehealth reimbursement was covered in broad strokes at the federal level during the pandemic’s onset, but those hasty standards left providers to navigate a new, unprecedented healthcare system. As time passes, lasting change that benefits both patients and providers needs to be made at the federal level. Until then, states are left to individually determine telehealth coverage. And the delineation of care along state lines is a massive barrier impeding telehealth’s impact.
Payment parity is just the first in a long series of hurdles we must clear to leverage telehealth for the long term. Compliance regulations will be reinstated, and when they are, platforms like Zoom or Microsoft Teams will be found lacking in their ability to support virtual visits. Telehealth isn’t just a video connection, but a platform designed specifically for patient-provider interactions. Institutions building out comprehensive digital strategies will need to employ solutions that integrate with existing workflows, rather than changing workflows to include them. Technology that integrates into existing EHR and patient experience platforms will drive the replacement of short-term solutions. Capabilities like language interpretation services, medication prescription, and patient information access – all from within the same platform – will determine which solutions lead the market in coming months.
At its most powerful, telehealth connects people at any time, over any distance, and in any language. Great telehealth fits within existing care workflows and serves both clinicians and patients. Healthcare has the potential to seismically shift by redistributing specialists not just across the country, but globally, with digital resources. Worldwide virtual care could all but remove distance, time, and cost barriers to patient care. Continued telehealth expansion could ensure uninterrupted availability of experts, second opinions, and dedicated care staff. Providers’ peer networks could expand exponentially.
Here’s the catch: to reap the benefits of coordinated, global, unlimited, digital healthcare, we first have to tackle payment parity. Until we address healthcare coverage at a national – or even international – level, we depend on states to individually shape the future of telehealth.
“Ideally, payment parity laws should not prevent the parties from negotiating for different reimbursement rates for telehealth vs. in-person services, so long as such negotiations are truly voluntary by the provider and not forced upon them,” he says. “Well-drafted payment parity laws can level the field for providers to enter into meaningful negotiations with health plans as to how telehealth services are covered and paid.”
Nathaniel Lacktman, Partner & Chair of Foley & Lardner Telemedicine & Digital Health Industry Team
“Will Telehealth Payment Parity Be Permanent or a Passing Fancy?”
