Should telehealth expansions be made permanent after the COVID-19 pandemic? And if they do become law, how can equity be ensured?
HHS Secretary Xavier Becerra and Jack Resneck Jr., MD, president-elect of the American Medical Association (AMA), weighed in on these and other questions during an interview with the Washington Post on Thursday.
Over 43 new bills related to telehealth and remote patient monitoring have been introduced over the course of the pandemic, according to the Alliance for Connected Care.
“We are absolutely supportive of efforts to give us the authority to be able to utilize telehealth in greater ways,” said Becerra, referring to his agency.
The Biden administration is striving to guarantee equity and accountability, he said, and if telehealth is expanded it’s important to make sure that it doesn’t lead to health disparities.
“We’re going to do everything we can to include everyone,” Becerra said, adding that a person’s zip code shouldn’t determine their access to telehealth. “There are circumstances in which you don’t need to have a smartphone … any kind of phone might be enough.”
As for holding providers accountable, “we don’t want to be billed for things that don’t result in better health for Americans,” he said.
Resneck, a dermatologist who practices in the San Francisco Bay Area, said that the AMA also fully supports the expansion of telehealth waivers. “I don’t think my patients want to go back to the way things were a year and a half ago, when this wasn’t an option,” he added.
Resneck was careful to note that the fact that insurers expanded coverage was what made telehealth visits possible.
Prior to the pandemic, Medicare policies, in particular Section 1834(m), only allowed audiovisual telehealth in certain geographic areas, or only allowed it to be used to connect one doctor to another doctor in an office setting. In other words, most patients couldn’t use their own devices to connect with a doctor.
It is these kinds of regulations, which were waived during the public health emergency, that the AMA is urging Congress to make permanent. That said, the AMA is also concerned about some of the changes that private insurers have made to telehealth coverage.
Some of Resneck’s own patients aren’t allowed to do a follow-up visit with him over video, but their insurance company will allow them to see an internet-based corporate telehealth provider with whom they don’t have a relationship, and who don’t have access to patients’ medical records.
“We’d like to see [private insurers] expand and continue the option for our patients to be able to see the healthcare team and the physicians that they already know and who know them,” he said.
“We also don’t want insurance companies telling individual groups of patients that either they can’t use telehealth or that they have to use telehealth, or have to pay extra to come in [to an office] in person,” he added, noting that in certain instances, telehealth cannot replace an in-person visit.
For example, a patient with skin cancer might need a full-body skin check to look for new cancers or a biopsy, he explained.
When it comes to physician licensure, however, Resneck does not want certain policies that were relaxed during the pandemic to be made permanent. The purpose of physician licensure is to allow states to hold physicians accountable for the care they deliver, he noted.
This is another point on which Becerra agreed with the AMA. “The farther you go from the direct connection between patient and provider, the more difficult it will be to try to provide for the accountability,” he said.
“We can track down that doctor 30 miles away from you, but if your doctor was 3,000 miles away from you, that’s a tougher sell for a consumer who’s now trying to get accountability for a service that wasn’t properly provided,” he added.
However, the AMA does favor interstate medical licensure compacts, where physicians with licenses in good standing in one state can secure a license in another state in that compact.
The AMA is asking state medical boards to make exceptions to allow physicians to continue to care for patients who are temporarily out of state, such as “snowbirds” and college students, Resneck said.
The association supports other exceptions as well. “There are all types of emergencies, natural disasters … where we see physicians and other members of the healthcare team eager to really run towards the fire and provide care,” Resneck continued.
For example, early in the pandemic, before California was hit with its own wave of COVID cases, the University of California San Francisco, where Resneck works, sent many physicians and nurses to New York and to the Navajo Nation, where the situation was worse.
A lot of state medical boards will make allowances during a declared emergency to allow physicians and other clinicians to help provide care, he noted.