The COVID-19 pandemic has taken us into a Twilight Zone-esque realm of existence where alcoholic beverages can be delivered to our doors; the 9-to-5 office model has been proven outdated; and we’ve been given the time and privilege to question the practicality of many of the laws and habits that governed our lives before.?
In this liminal world, everything’s being reconsidered, like telehealth, for example.
Before COVID, telemedicine was rarely used. Despite being a cost-effective, accessible and 21st-century alternative to the traditional in-person doctor’s appointment, there were hurdles to setting it up: workflow reconfiguration, high startup costs, patient interest and varying coverage policies across insurers made it extremely difficult to use. It was a complicated system to integrate into a practice, let alone navigate on a day-to-day basis.?
But on March 17, when Governor Cuomo announced the statewide lockdown and revealed his 10-Point Plan, point eight leaned on telehealth as an essential tool to curb the spread of the virus. The federal government followed suit, waiving various requirements and/or limitations to utilizing telehealth. Since then, both moves revealed the utility of telehealth as a tool in the healthcare industry.?
But as states begin to reopen, it looks like telehealth’s viability as an in-person appointment alternative may be short-lived, ending as soon as the state of emergency does. Existing parity laws, nationally, meant to guide usage of telemedicine, are actually the greatest obstacle to utilizing it.?
In an article for Filter Magazine, Dr. Elizabeth Ryan and the staff at REACH, a stigma-free healthcare provider located in Ithaca, said they were worried they’d end up with low patient volume as telehealth looks poised to be phased out. Since many of its patients already struggled with drug addiction or special health needs, they were concerned by what a lack of access to proper treatment might result in.
Currently, there are only 10 states that offer “true” parity laws (New York isn’t one), according to a Foley report. Parity laws are designed to ensure that healthcare plans cover telehealth appointments at the same percentage as in-person appointments, thereby incentivizing healthcare providers to invest in telehealth care but, in New York, the opposite has happened. Low payment and reimbursement rates among health insurers has caused providers to either turn away from telehealth as a reliable, profitable healthcare tool or bear the revenue loss. Many end up choosing? the former.
“Without payment parity, a health plan could unilaterally decide to pay network providers for telehealth services at 50 percent of the reimbursement rate that the health plan pays the provider for an identical in-person service,” states the Foley report. “This is not a theoretical risk, [it] actually occurred when New York implemented its broad telehealth coverage law, which did not include any language regarding payment/reimbursement rates.”
Failing parity laws can be seen as one of the major contributing factors to decreases in-patient volume across all medical practices following the start of COVID-19. Having little experience with or no existing telehealth service in place, health care providers and thereby patients were left at a severe disadvantage in March as the government turned to the inoperative alternative as a solution. The government had essentially passed the responsibility of patient care onto an ill-prepared healthcare system.?
Patients have demonstrated a commitment to receiving healthcare when given the opportunity through alternative means not previously seen in traditional healthcare routes.
In a Harvard University study, performed with the healthcare technology company Phreesia, researchers revealed the devastating impact COVID-19 was having on U.S. outpatient care. The study revealed that in the wake of the state of emergency order, primary care outpatient care had dropped by nearly 50 percent, among the lowest. Specialty practices saw the highest drops.
The study also says that as in-person visits dropped drastically, telemedicine visits rose rapidly in April before plateauing over the last three weeks. The decrease in telehealth visits is due to the reopening of practices nationally as more doctors return to in-person treatment.?
The team at REACH credited the federal waiver with saving their practice, and, very likely, many of their patient’s lives. REACH, which caters to NY residents in over 26 counties, said that without the barriers to implementing the telemedicine, they were able to switch their entire practice over to telemedicine and they’ve since seen results they never expected. After establishing a telehealth option, they took on 53 new patients in April.
Samantha Stevenson, Practice Manager at REACH, said that the staff spent 10 days switching the entire practice over to the telemedicine app Doxy.me, but not worrying about navigating health insurance policies has allowed them to focus on what’s important— providing care to patients.
“Now that we’re recognizing that we can truly save people’s lives, we can’t go back. Morally. Ethically. We cannot go back,” said Stevenson.?
Over 90 percent of REACH’s client base uses Medicaid: they say that it’s also part of their mission. They are one of the few practices in the area that takes Medicaid and prescribes Suboxone and Buprenorphine. Acknowledging the spike in patient care, they can’t go back to the way things were, but there’s also very little money in providing the service.
“If we go back to the way things were before COVID, none of the types of visits we do are covered by parity,” says Ryan, “and there’s a common misconception that Medicaid pays for services — it approves services, but it doesn’t pay well. A 40-minute appointment can often end with a $14 reimbursement, not even enough to cover a decent fraction of a salary. I think it’s all or nothing for us. It’s not going to be okay if they give us 50 percent of an in-person visit. It’s not okay if they keep the parity, but the patients have to be at a doctor’s office to receive treatment. That defeats the purpose.”
“The incentives are wrong in American healthcare and this is one small way that has accidentally gone in our favor, and we need it to continue.”