Flexibility, Equity, Payment Top AAFP Telehealth Guidance

Federal telehealth policy emerging from the pandemic, the Academy told the White House in a March 28 letter, should improve broadband infrastructure for patients while protecting their privacy and data security, standardize coverage and payment across all payers and payment models, and advance EHR interoperability without adding to physicians’ administrative burden.

The Academy was responding to a request for information titled “Strengthening Community Health Through Technology,” published Jan. 5 in the Federal Register. The letter was sent to Alondra Nelson, Ph.D., director of the White House Office of Science and Technology Policy, and signed by Board Chair Ada Stewart, M.D., of Columbia, S.C.

“When implemented intentionally and appropriately, digital health technology can advance health equity by enabling patients with transportation, time, distance and language barriers to connect with their trusted primary care physician,” the Academy wrote. “However, not all patients have equitable access to telehealth services or confidence in using digital health technologies. Access to broadband for Black and Hispanic Americans is an estimated 10 years behind that of white Americans.”

Closing access gaps should coincide with efforts to address physician expenses and enhance EHR interoperability to improve care coordination while helping primary care physicians address unmet needs, the letter added.

“Since the pandemic began, physicians have absorbed unique costs and resources to integrate telehealth software into existing clinical workflows and EHRs, hire additional staff or increase staff compensation to cover both in-person and virtual visits, assist patients in using telehealth correctly, respond to sharp increases in electronic messages from patients, and ensure physician malpractice or liability insurance covers telehealth. Payment for telehealth and other digital health services must account for these costs and support the integration of telehealth into the medical home.”

To improve health equity and support physician practices, the Academy urged the White House to

• adopt telehealth coverage and payment policies “that facilitate and encourage equitable access to high-quality telehealth services within the medical home and support physicians’ ability to choose the most appropriate modality of care;”
• maintain telehealth flexibilities, including Medicare coverage of audio-only services, for at least one year after the PHE ends;
• analyze data on telehealth use and its impact on patients as well as physicians;
• expand federal programs that provide patients with resources to conduct video visits or access their electronic records;
• work with Congress to create a pilot program to fund digital health literacy and other patient-assistive programs;
• implement appropriate payment for electronic communication and evaluations that physicians provide for the medical management of their established patients;
• work with the Office of the National Coordinator for Health IT to improve patient privacy and security; and
• invest in interoperability and reducing the complexity of inputting data.

The AAFP voiced similar concerns and recommendations in a March 9 letter to the U.S. House Healthy Future Taskforce Modernization Subcommittee. Among other actions, the Academy called for lawmakers to pass the Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act (H.R. 4770), which would direct HHS to further study Medicaid and Medicare telehealth use and patient outcomes (including by race, ethnicity, location and income). Both recent letters reiterated and brought current a number of points made in the Academy’s strong Senate testimony last year.