Policy Brief on Telehealth Parity Policy

Executive summary
The American federal government has declared its decision to promote and incorporate telehealth services into healthcare coverage for its citizens. Obamacare adopted this practice only federally, via Medicare, and that too in specific situations. The authority of deciding telehealth services to be provided under Medicaid chiefly continue to be under state government jurisdiction. Major barriers challenge telehealth acceptance and adoption, with the overall country and individual states unable to fully appreciate telehealth’s cost-effectiveness. The proposed Telehealth Parity Act (TPA) will revolutionize Medicare telehealth reimbursement, besides expanding Medicare recipients’ coverage. States will perhaps slowly do away with their respective parity-related regulatory restrictions which constrain professionals and organizations, shifting their emphasis to telehealth integration into routine healthcare coverage.
Introduction
Telehealth tools will aid practitioners in providing superior-quality, economical healthcare, which is crucial to the growing value-based imbursement trend. All things considered, telehealth boasts significant advantages if the healthcare system expends more efforts that can potentially deal with or alleviate associated problems and risks. At present, state and federal statutes and rules impact telehealth within the nation. The absence of a consistent legal telehealth strategy remains a key issue. Specifically, concerns revolving around reimbursements in case of public initiatives (e.g., Medicaid) as well as private insurance firms constrain telehealth adoption. Poor or no reimbursement to particular telehealth services in comparison to direct services lowers incentives to offering telehealth services (“Health Policy Brief” 2016). In this paper, approaches to realize a health sector-initiated state telehealth policy will be discussed.
Approaches and results
The proposed TPA will revolutionize Medicare telehealth reimbursement, besides expanding Medicare recipients’ coverage. Eligible geographic locations will also increase. For deriving associated benefits, states will probably take a step towards telehealth-related total parity statutes. In the absence of parity, not much incentive remains to provide telehealth services or develop the telehealth arena further (Weinstein et al., 2014). The absence of such incentive will cause practitioners to continue relying on direct care, leading to the continuance of steep healthcare expenses, continued problems of accessibility and potential decreased chronic care standards (in case of patients benefiting from remote observation services).
Moreover, states will probably slowly do away with their respective parity-related regulatory restrictions which constrain professionals and organizations, shifting their emphasis to telehealth integration into routine healthcare coverage. Reimbursement will perhaps ultimately include remote observation and store-and-forward practice, as well as portable tools and smartphone apps (Neufeld, Doarn & Aly, 2016).
States continue to maintain considerable power when it comes to the telehealth services Medicaid covers and reimburses. A majority of them fail to reimburse telehealth-connected electronic mail, fax or telephone communications. A scant four states permit physician telehealth reimbursement and nineteen states have limited type of provider to only nine. Washington D.C. and 15 other states have no provider type-based reimbursement limitation. However, most states don’t limit rural area-specific Medicaid telehealth reimbursement, as opposed to existing Medicare requirements.
Several states have made reimbursement mandatory, but they all do not necessitate reimbursement similar or identical to direct, face-to-face services. Regulations necessitate telehealth service coverage by healthcare insurance businesses to be to the very same degree as direct services. However, numerous state-wide variations may be seen in private insurance firms’ and states’ coverage details and reimbursement methods (Neufeld et al., 2016). These variations have led to significant nation-wide telehealth coverage disparities.
Conclusion
The US federal government, via the Affordable Care Act, offers certain incentives (reimbursement, grants, etc.) for state-level telehealth development. Furthermore, it mostly allows states to decide Medicaid telehealth adoption or reimbursement, whilst itself participating in influencing Medicare telehealth services. Restrictions imposed on these initiatives offer states a hardly-perfect model to follow.
States largely control telehealth reimbursement plans within state Medicaid initiatives and via private insurance regulation. More controversial and interesting are statutes on telehealth parity necessitating identical or similar reimbursement for telehealth and direct services. In the absence of parity regulations, health plans may disburse telehealth service providers at a fraction of the fees allotted to direct care services (“Health Policy Brief,” 2016). Several state telehealth coverage regulations do not incorporate parity language; i.e., certain states that offer telehealth coverage have failed to implement required cost reimbursements for incentivizing providers to prefer telehealth to face-to-face services.
Implications and recommendations
Telehealth possesses considerable possible advantages; care delivery through telecommunication technology poses distinctive challenges and risks to healthcare centers and professionals. A few key areas of interest affected by this policy are: the risk of collapse of the patient-provider relationship (e.g., inability of carrying out complete consultation); issues linked to health information quality (e.g., inaccessibility of complete patient clinical records); and organization-related challenges (e.g., infrastructure design and development related issues) (Dorsey & Topol, 2016; “Health Policy Brief,” 2016). Further, the policy will potentially resolve barriers to telehealth adoption, including state coverage disparities, unsolved issues of reimbursement and healthcare service consumer privacy, doctor licensing requirement disparities, etc. Concerns pertaining to malpractice liability have aggravated as well, with the shift towards increased telehealth service provision. Liability policy, for instance, typically specifies coverage availability only in case of claims lying within a given jurisdiction. Telehealth providers taken to court in another state (i.e., not the state they are covered in) may lack coverage for paying indemnity in case of negative judgment or defending their claim. The proposed law promises to resolve the above issues.
With the nation’s progress from volume-based, unsynchronized patient care delivery to a patient-focused, value-based, cohesive system, greater emphasis on cost-cutting, increased accessibility and better quality is recommended. To facilitate healthcare facilities’ provision of round-the-clock, superior-quality, cost-effective patient care anywhere, telehealth interventions may prove valuable.


References
Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. New England Journal of Medicine, 375(2), 154-161.
“Health Policy Brief: Telehealth Parity Laws,” Health Affairs, August 15, 2016
Neufeld, J. D., Doarn, C. R., & Aly, R. (2016). State policies influence medicare telemedicine utilization. Telemedicine and e-Health, 22(1), 70-74.
Weinstein, R. S., Lopez, A. M., Joseph, B. A., Erps, K. A., Holcomb, M., Barker, G. P., & Krupinski, E. A. (2014). Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. The American journal of medicine, 127(3), 183-187.