The pandemic emergency required innovations that allowed millions of patients greater access to virtual health care, and could become permanent, say researchers.
Public policy changes are required to ensure continuing access to telehealth services, says the research paper, “Virtual Health in a Post-COVID World: Optimizing Regulation, Reimbursement, and Regularity,” by Robert Graboyes, Ph.D., Darcy N. Bryan, M.D., and Lyle Berkowitz, M.D., published by the Mercatus Center at George Mason University on March 8.
There are barriers to the telehealth model of medical practice, say the authors.
“In the case of expanding virtual health, obstacles include regulatory hurdles at the state and federal levels, poor or nonexistent reimbursement for any care outside the traditional face-to-face visit, and cultural resistance from both patients and providers to doing things differently,” write the authors. “Real progress will require coherent regulatory reforms, appropriate reimbursements, and cultural acceptance (regularity) to sustain a broad vision of virtual health.”
Pandemic Expanded Telehealth
Reacting quickly during the pandemic was a real challenge for government officials, says Graboyes, a senior research fellow and health care scholar at the Mercatus Center.
“For policymakers (legislative, executive, regulatory), pre-COVID years saw a moderate flow of questions to resolve,” Graboyes told Health Care News. “During the pandemic, questions came at them as if out of a firehose. For the most part, they responded well.
“They opened new avenues for care with astonishing speed,” said Graboyes. “Telemedicine went from the remote edges of care straight to the center of American medicine in the span of a month or two, and this required an epic reduction in legal and regulatory obstacles. The challenge now is how to retain this new sense of openness and experimentation.”
The paper aims to address the concerns of health care providers and entrepreneurs, says Graboyes.
“Health care providers are a critical audience not only because of their intimate relationship with patients but also because they are extremely influential with policymakers,” said Graboyes.
“Health tech entrepreneurs are a key audience because they are developing new virtual care technologies at a rapid clip, and understanding the reactions of policymakers and health care providers will be crucial to their success,” said Graboyes. “It is these entrepreneurs—these creators—who will ultimately provide the technologies to quell the fears and answer the questions asked by policymakers and providers.”
The pandemic showed virtual medicine can help address the longstanding problem of deploying highly trained people to the places where they are needed, says Graboyes.
“For instance, if physicians in one locality are pushed to their limits by, say, an epidemic, then remote doctors can relieve some of the pressure by handling some of their caseloads,” said Graboyes.
“We have something of a crisis in care for rural areas, and virtual care can fill some of those gaps, too,” said Graboyes. “Furthermore, virtual care facilitates the ability to shift some care to nurse practitioners, physician assistants, and others—with the option of transferring to a physician when needed.”
Virtual care also makes it possible for specialists to serve patients nationwide, says Graboyes.
“Not every community can have a world-class neurologist,” said Graboyes. “Many cannot attract any neurologist at all. With virtual care, any community with an internet connection can access top-level specialty care—at least to some degree.”
Physicians Accept It
Health care providers adopted virtual technology during the health emergency, says Merrill Matthews, Ph.D., resident scholar with the Institute for Policy Innovation.
“Even though telehealth has been available for several years, it took the pandemic to push the medical community into embracing it,” said Matthews.
Physicians are generally cautious about their practices, says Matthews.
“First, doctors are typically very slow to embrace changes in a medical model that has been practiced for centuries,” said Matthews. “While many were quick to adopt innovative products such as iPads as tools, such tools were aids to providing health care the way doctors had always done it—not a new way to provide care.”
However, doctors now view virtual health care positively, says Matthews.
“A poll by the American Medical Association poll last January found that 85 percent of the physicians surveyed said telehealth increased timeliness of care,” said Matthews. “And 75 percent said it allowed them to deliver high-quality care. My guess is telehealth is here to stay, at least for certain health care providers who will find ways to integrate it into their practices.”
Telehealth presents issues that need to be resolved, such as reimbursement for services, says Matthews.
“Should a doctor receive the same amount for a telehealth visit as an in-person visit?” asked Matthews. “Doctors thought so. Insurers have generally wanted to pay less for a telehealth visit. But how much less, and will doctors think low telehealth reimbursements may not be worth their time?”
The government also presents hurdles for virtual medicine, says Matthews.
“Different states differ in their willingness to embrace, regulate, and pay for telehealth, as are different private-sector health insurers and Medicare and Medicaid,” said Matthews.
Kenneth Artz (KApublishing@gmx.com) writes from Dallas, Texas.
Robert Graboyes, Darcy N. Bryan, M.D., and Lyle Berkowitz, MD, “Virtual Health in a Post–COVID World: Optimizing Regulation, Reimbursement, and Regularity,” Mercatus Center, March 8, 2022: https://www.mercatus.org/publications/healthcare/virtual-health-post%E2%80%93covid-world-optimizing-regulation-reimbursement-and