Telehealth: Medicare Needs to Get With the Program

Three months ago, at the end of December, President Biden signed into law a $1.7 trillion omnibus spending package that covered the gamut from defense appropriations, to funding for Ukraine’s military in its war with Russia, to emergency disaster assistance for the west and southwest areas of the country impacted by natural disasters. Buried deep inside that 4000 page document was also a two-year extension of a number of telehealth provisions for Medicare patients. Some may react by saying, “That’s great.” However, I say, “Why was that extension for only two years? Why not forever?”
   

With the onset, in early 2020, of COVID-19, the use of telehealth exploded, as both public and private insurance companies agreed to reimburse remote visual—and in some cases, telephonic—patient visits with providers. Not only was the permission both essential and lifesaving, but it also resulted in the electronic modernization of health care facilities and practices across the country. The coronavirus inadvertently acted as a grand experiment that was wildly successful, not unlike many accidental inventions.
   

As the manager of a primary and specialty health care facility I had co-founded some four years earlier, I saw the benefits firsthand. For our more than 2500 patients spread across a geography that covered hundreds of square miles, it was not uncommon for many of them to travel well over an hour for a visit with one of our providers. Telehealth offered a significant improvement in both the quality of life for our patients and the productivity of our operations. Without telehealth, there was, in essence, no heath care during that time.
   

The monumental success of telehealth across the country—and around the world— is not an argument for the eradication of in-person meetings with a provider. Far from it. Hands-on treatment will always play an essential role in the practice of medicine. That being said, the technological tools now available to medical providers allow for a consequential portion of health care to be conducted with face-to-face electronic interaction. The benefits for the patient—fewer lost hours at work, often with a commensurate negative impact on earnings, as well as eliminating the hassle and expense of travel—are both monetary and psychological.  Important benefits also accrue to the organizations that provide health care, by reducing the costly impact of a “no-show” or last-minute cancellation by a patient. Telehealth visits allow healthcare providers to work a more productive day.  
   

Think about it this way—before Covid-19, telehealth was a rarely-used feature of healthcare. The Federal Government, through Medicare, had proscriptive regulations on what it would cover for reimbursement. The global pandemic shattered the myth that in-person visits were always superior to telehealth visits. That leads to the question: Why should what was invaluable and lifesaving during the pandemic have lost its value post-pandemic? I argue, and I think most would agree, that is a preposterous notion. I also argue that not only should telehealth be fully embraced, but it should also be expanded, most particularly by eliminating state-line barriers for reimbursing patient-provider visits.
   

So why is the Federal Government not at the forefront of promoting telehealth as a state-of-the-art solution to the problems that plague the health care system in this country? Problems that include: (a) a nationwide shortage of providers and clinic support staff—and please note that shortage is prevalent not only in rural American but in almost every town and city in the country, (b) insufficient preventative care, particularly for the elderly and those who live on the margin.
   

Unfortunately, the Federal Government’s concern—as outlined in its own Government Accountability Office’s (GAO) report in 2021—is that telehealth will increase Government outlays for health care. In and of itself, a telehealth visit is no more or less expensive than an in-person visit. The same medical expertise is provided, only in the case of telehealth, it is without the patients having to spend time, that they often don’t have, to get to a doctor’s office or a clinic.
   

The Government’s worry about cost is pennywise and pound foolish. In essence, it is concerned that telehealth makes it too easy for patients to receive care because it reduces the number of broken and cancelled appointments. What a pathetic approach to cost benefit analysis! Benjamin Franklin’s maxim, “An ounce of prevention is worth a pound of cure,” is obviously not understood or appreciated by our Federal Government.  The myopic lens through which the government views costs misses the entire point that preventative medical care in the present can go a long way to eliminating crisis care in the future. A trip to a hospital emergency room will be many fold the cost of a telehealth visit. A sound cost benefit analysis would consider the expected reduction in future emergency care costs that result from timely visits with a provider in the here and now.  
   

Let me end on a positive note by saying that the preponderance of the evidence regarding the benefits attributable to telehealth is so overwhelming that I have to believe the Federal Government will be pressured, or maybe even shamed, into accepting it as the norm. Even if the government keeps kicking the can down the road with one- and two-year extensions, it will be unable to roll back the advances of technology. Telehealth is here to stay and here to grow and here to benefit us all.