Telehealth Is Calling. But Will the Health Care System Have the Answers?
Telehealth can help to ease the strain on a health care system that is stretched to the limit, says Mei Wa Kwong. But the executive director of the Center for Connected Health Policy says reimbursement and adequate training are obstacles to telehealth becoming part of everyday health care. The center, a not-for-profit organization in Sacramento, is the federally designated National Telehealth Policy Resource Center, and it provides technical assistance to a dozen other federally funded telehealth resource centers. Kwong, who has been executive director for a year, started at the center in 2010 as a policy associate.
What kind of progress have you seen in the past six months or year regarding telehealth?
We’ve seen an increased interest and increased push in expanding policies regarding telehealth both on the federal and on the state level. What recently spurred the changes is the widespread realization that our health system really needs to rethink how to deliver care because we do have limited resources. We have a shortage of health care providers in a multitude of areas.
What also really spurred it is the opioid epidemic. We’re facing this public health crisis. How are we going to address it? We also realize we have a shortage of people who can address this type of situation. A lot of folks where you have high incidence of opioid use disorder are located in areas where they don’t have ready access to health care professionals who provide the services to help them. They may be in rural areas. So how are you going to get the services to these folks? This is one possible way—through telehealth.
What are some of the remaining barriers to adoption and usage?
Reimbursement is always going to be one of the top ones. How do you pay for this? Reimbursement also dictates how you use the technology to provide a service and for what services. If you won’t get paid for it, most likely you won’t have a provider who utilizes the technology. The way our policies are set up really dictate where it can take place, who can provide services, and what services can be provided.
I was talking about the opioid crisis and how it impacts rural areas. You still have connectivity issues. They don’t have certain providers in certain areas, but they also have these connectivity issues.
[Another issue is] how do you utilize telehealth when you’re talking about a prescribing situation? A lot of the time, a telehealth provider may not have seen the person in person. With prescribing, especially when you’re talking about a controlled substance, you either need to have that in-person exam with the patient or you need to fall into a very narrow exception that’s out there for telehealth. Prescribing for controlled substances is controlled by federal law. That impacts addressing the opioid crisis because a lot of programs that treat opioid-use disorder use controlled substances to wean a person off whatever they may be addicted to.
What kind of impact might come from the FCC’s decision to move forward on a proposed program to expand telehealth services to underserved populations?
I don’t think $100 million would probably be adequate enough for what they’re trying to do, especially because they are looking at 22 states. Just do the math. That’s less than $5 million per state to try to address the connectivity issue.
Sometimes pilots might be set up where they [tell providers,] “Here’s some money. Go provide these services.” That’s great, but do they equip them fully to be able to do that?
For example, if you’re giving money for a bunch of community health clinics and we want them to start a telehealth program to address opioid-use disorder, that’s great, but did that provide adequate funding for them to know how to start a program if they don’t already have one in place?
Because telehealth is not as simple as, “I have money. Great—now I pop open my laptop and I do this.” There’s a lot more involved. It’s a complete change in how they’re providing services. There’s a lot of investment on the provider side setting up protocols—training their staff, understanding how they’re going to do all this, and that takes some time and also takes some knowledge of how to guide folks through that.
CMS has changed its rules to allow Medicare Advantage plans to expand telehealth services. What kind of impact might that have?
It is something Medicare Advantage plans have been asking for—more flexibility. It’s great that it’s come out. I’ve been talking to a couple people, and they do think it’s come out a little too late in the year for a lot of plans to make that adjustment for 2020. There may be a one-year delay for some plans, just simply because they haven’t had time to make that adjustment.
Is there a time frame when you would anticipate telehealth will be more widely used?
I don’t think it’s going to happen overnight. I think we’ll see gradually more and more expansion. The policies may have opened things up for providers to use telehealth more. The question is, are providers going to take advantage of that?
It’s going to be interesting to see where we are over the next five years, because policy still needs to evolve. And once the policy is in place, it will still probably take a couple of years for it to be put into practice.
If telehealth takes off, where do you see it providing the most benefit?
It’s already pretty accepted as a way of doing behavioral health, but there’s such a need for those services out there. That is definitely an area that can take off very quickly. A lot of studies show the efficacy of using it [for behavioral health]. Because you can do it anywhere—you can do it in the comfort of your home—it might make people more willing to seek out help.
One of the missing factors for telehealth is the awareness factor, not necessarily on the provider end, but on the consumer end. How many regular, non–health care people know about telehealth? It’s still not a commonplace thing for folks to think of when they think about how they can get care.