Telehealth has the potential to solve some of healthcare's toughest problems, from provider workforce shortages to the opioid epidemic. However, in order to use telehealth to its full potential, we must understand the unique legal and regulatory challenges involved in its delivery.
As telehealth advocates, Vituity was excited to be invited to the Center for Telehealth and E-Health Law (CTeL) Fall Executive Summit in Washington D.C. In this post we'll share:
- Top insights gained from the summit.
- How providers can influence telehealth policy at the state and federal levels.
- How Vituity is using lessons from the summit to improve care for patients and clients.
What is the CTeL Executive Summit, and why does it matter?
The mission of CTeL is to overcome the legal and regulatory barriers that impact the utilization of telehealth and related e-health services. CTeL provides education and support on topics like regulatory updates, licensure, parity laws, Medicare and Medicaid reimbursement, and private insurance policy.
CTeL's seasonal executive summits are small, invite-only events. Among the 200 attendees present at the December 2018 summit were:
- Government agencies, including CMS, DOJ, and DEA
- Representatives from academic medical centers, health systems, and telehealth resource centers
- Representatives from state government, especially boards of medicine
- Federal legislators and staff
- Telehealth providers
- Lawyers and consultants
The CTeL Executive Summit was a learning and collaboration conference, as opposed to a technology or sales showcase. Sessions focused on exploring innovative solutions to legal and regulatory issues in telehealth.
Here are some of the key insights we gained:
Federal regulations are major barriers to telehealth delivery.
The Congressional Budget Office currently recommends restraint around telehealth expansion, citing concerns about runaway costs and undemonstrated benefits. As a result, Centers for Medicare and Medicaid Services (CMS), the nation's largest payer, continues to take a very conservative approach to telehealth reimbursement. For example, Medicare still limits telehealth reimbursement to rural and underserved areas. In addition, only patients located at specific "originating sites" (e.g., hospitals, physicians' offices, and certain types of clinics) are eligible for telehealth coverage.
Medicare's strict reimbursement rules constrain states that wish to expand telehealth services to their citizens. Healthcare organizations trying to deliver better care and meet the Triple Aim may also receive limited reimbursement for telehealth innovation.
Another consequence of CMS' conservative approach is that reimbursement issues are addressed in isolation rather than as part of a broad, well-articulated policy. For example, Medicare recently expanded its coverage of telestroke services. While this is a small victory, it doesn't address other issues that may arise during a teleneurology consult. Nor does it touch the larger challenges facing healthcare that could be solved by a more systemic approach to telehealth regulation.
Expanding CMS reimbursement would encourage wider telehealth adoption and innovation. Hospitals, physician groups, and professional organizations can help to improve healthcare access by advocating for changes to the telehealth payment model.
The opioid crisis may be the catalyst that finally pushes federal telehealth legislation forward.
On average, 130 Americans die each day from an opioid overdose. The U.S. is currently experiencing a shortage of psychiatrists and substance abuse specialists to treat patients with opioid use disorder (OUD). Telehealth is one of the most effective ways for our limited psychiatric workforce to reach millions of patients in need.
One major barrier to treating OUD via telehealth is the Ryan Haight Online Pharmacy Protection Act of 2008. The law was originally created to combat the proliferation of rogue Internet pharmacies selling controlled substances online.
At the time Ryan Haight was passed, telehealth was in its infancy. But as telehealth practice has evolved, the law has not been amended to keep up. As a result, Ryan Haight now constrains psychiatrists from offering highly effective medication-assisted treatment to OUD patients. (Medications used to treat opioid addiction such as buprenorphine and naloxone are themselves controlled substances.)
Congress has shown a cautious bipartisan interest in amending the Ryan Haight Act to allow for wider e-prescribing of medication-assisted therapy by physicians for the treatment of OUD. This would allow patients in rural and underserved areas to receive the latest evidence-based treatments for OUD.
The scale of the opioid epidemic and lack of providers to treat it may well serve as a catalyst for telehealth expansion. Providers and policy organizations can further the cause by lobbying for fair e-prescription rules and wider reimbursement.
Lawmakers are interested in telehealth policy, and it's up to stakeholders to keep the issues in front of them.
Telehealth has the potential to address many healthcare challenges that are part of the national conversation:
- Physician shortages
- Cost inflation
- Chronic illness management
- Quality improvement
- The opioid epidemic
One of the most exciting parts of attending CTeL's Executive Summit was the opportunity to hear directly from legislators interested in telehealth policy. We also had the opportunity to meet with the staffs of senators Dianne Feinstein and Kamala Harris. Both teams were very receptive and engaged as we made our presentations on the importance of telehealth policy reform. While legislators at both the state and federal level appear open to telehealth advocacy, we also realize that they deal with many competing priorities.
As providers and patient advocates, we at Vituity believe it's important to continue building relationships and doing our part to keep telehealth issues in front of lawmakers. We're therefore committed to advocating for greater government buy-in for this important means of providing care and expanding access.
Putting insight into action
Most telehealth programs follow a direct-to-consumer model. As such, they're designed to manage single events and simple problems that don't require follow-up. By contrast, Vituity Telehealth leverages our integrated medical group to provide a full continuum of care to our organizational partners. This allows us to care for complex patients and assist in managing chronic illness.
Vituity Telehealth partners with health systems, hospitals, payers, public healthcare agencies, and other organizations to deliver care and manage patient populations. Our services include teleurgent care, teleneurology, telepsychiatry, telehospital medicine, and teleskilled nursing.
The CTeL Executive Summit drove home the importance of joining a broad coalition of telehealth partners as we strive to expand and innovate our Vituity Telehealth programs. If we can use telehealth to achieve great results for patients and communities, we will be in a much stronger position to advocate for improved telehealth policy.
To this end, we are looking at new ways to expand specialty care and service delivery using our Vituity sites as laboratories. This involves using telehealth to:
- Provide specialty coverage such at telepsychiatry, tele-ICU, and teleneurology via audio/video platforms to understaffed or remote clinical facilities.
- Optimize staffing levels and/or manage surge capacity of our practices, even at remote locations experiencing provider shortages.
- Improve clinical integration across our partner hospitals and health systems.
- Engage in complex care management and population health models.
- Use telehealth to expand the use Rapid Medical Evaluation, a front-end, quick-triage process that greatly improves emergency department throughput and patient experience.
The CTeL Executive Summit underscored both challenges to and opportunities for telehealth expansion. It also showed us that healthcare providers can — and indeed must — lead change in this arena.
As experts from the front lines of healthcare, we can speak with authority to the needs of patients and the limitations of the current system. We urge all of our fellow stakeholders to join us in advocating for this important cause.
Visit out telehealth page to learn more about our progressive solutions for care delivery.
Originally published March 13, 2019.