Provider conduct could have a big impact on the future of telehealth, experts say

• Widespread certification for telehealth could encourage policymakers to retain the waivers that have promoted expanded virtual access.
• Extensive research is needed to establish telehealth best practices and protocols.
• The benefits of increased telehealth utilization are seen in responses to a large new survey.

Congress and other policymakers will determine telehealth’s future place in the U.S. healthcare ecosystem, but experts say providers should consider their own roles in establishing the technology’s long-term viability.

The better that providers do in managing virtual visits, the greater the likelihood of an extension or codification of COVID-19 waivers that have allowed for expanded telehealth services, said Walter Panzirer, trustee with the Helmsley Charitable Trust, which works to improve healthcare access.

“All it takes is one real bad actor, one real bad problem,” Panzirer said this month during a Bipartisan Policy Center (BPC) webinar that examined the state of telehealth. “Regulations will come back into play.”

He added, “We need to look at this through a quality lens and really be accountable to each other to making sure that a telehealth visit should be the same — should have the same feel, the same equity and the same outcomes — as an inpatient visit. And to making sure that all institutions are doing this.”

Ensuring the quality of telehealth services

Mandatory certification for the provision of telehealth can help solidify the technology’s role in the healthcare infrastructure, Panzirer and other panelists said.

“If there is a certification, we have guidelines,” Panzirer said. “We have certifications and guidelines for quality of care and quality standards all across the field of medicine. Why not for telehealth?

“If you have those guidelines, you can hook that back to payment requirements, to making sure they’re meeting the quality outcomes and [that] this isn’t just the cheapest way of doing it.”

When the pandemic began, the National Committee for Quality Assurance accelerated efforts to include telehealth codes in the quality measures that are made available to health plans, said Kate Goodrich, MD, senior vice president for trends and analytics with Humana and formerly the director of CMS’s Center for Clinical Standards and Quality.

CMS and other stakeholders should follow suit, she said. She also called for “a research agenda” to “really understand deeply and precisely the impacts of some of these changes and the impacts of quality on different modalities of telemedicine delivery, including some of the concerns people have around payment.

“We need to actually study that to understand if it’s in fact true that telehealth increases costs. I think a lot of us believe that actually the opposite is true.”

Positive reviews seen in survey results

Consumer sentiments about their experiences with telehealth during the pandemic indicate the technology’s potential as a tool for improving healthcare quality and efficiency, according to findings of a large survey.

In the survey, which was conducted on behalf of the BPC, the research firm SSRS interviewed 1,776 adults by phone, including an “oversample” of seniors, rural residents and Hispanic and Black adults.

Eight in 10 respondents said their primary health issue was resolved via telehealth, with only 4% directed to follow up at an emergency department (ED) and 13% in person with their provider. Audio-only visits were just about as effective as video visits at resolving patient issues.

For every seven respondents who said they’d had a telehealth visit, one said they would have gone to the ED or an urgent care facility in the absence of telehealth access. And one in five would have delayed or bypassed care.

“There’s a lot that can probably be done by telehealth — more than we may necessarily realize,” Goodrich said.

For example, she said, a full physical exam may require an in-person visit, but new technologies may allow vital signs to be taken virtually.

Seeking out optimal approaches

Such possibilities point to another way in which comprehensive research is required to establish long-term telehealth processes and protocols.

“We actually have quite a bit to learn around what practices were occurring out in the field” during the pandemic, Goodrich said.

Near the start of the pandemic, Humana leveraged clinical data and data on social determinants of health to reach members who had greater medical or social needs and encourage them to consider a telehealth visit. Although the insurer makes telehealth services available through dedicated vendors, Goodrich said, the “vast majority” of members preferred to use telehealth through their primary care physicians.

Telehealth usage was higher among members who were attributed to practices that take on downside risk. “Most of these providers have oriented their practices toward improving the patient experience and improving health outcomes,” Goodrich said, meaning they either had a telehealth infrastructure already in place or worked quickly to implement one after the pandemic began.

But even if providers have the right incentives to offer high-quality telehealth, they may need some guidance in executing on the concept.

“We also have to make it easy and seamless for the professionals,” Panzirer said. “In the real world, that means having telehealth set up appropriately and simply in their office. Years ago, the physician would have to go down multiple halls and go to the telehealth consult room. It would be terribly inefficient on the physician’s time, so it doesn’t encourage uptake.”