Most of us have had at least one telehealth visit since the beginning of the pandemic. And for the majority of us, it was our first telehealth visit. Across the country, and the Northeast in particular, telehealth saw an unprecedented spike due to stay at home orders and limitations on PPE. At the Quality Institute, we see the value of telehealth — and we want the technology to reach its full potential to advance health care access, equity, and affordability. Right now, a bill sits on the desk of Gov. Murphy that would make permanent many of the changes to accessibility and reimbursement of telehealth that were implemented during the public health emergency and that continue today.
The bill includes some key modernizing features, such as authorizing the use of various types of virtual communications platforms and allowing state-licensed providers and their state resident patients to be located anywhere for the visit. These changes add welcome and practical flexibility for accessing care. But other aspects of the bill cement into law very prescriptive requirements for both payment and provider and patient communication and engagement before we have much data on how telehealth has been working at mass scale over the last 18 months.
Therefore, we propose that a logical improvement to the bill would be to add a three-year sunset clause. A sunset clause has multiple benefits. First, for the short term, it would keep the current reimbursement rates for telehealth visits in place, which would incentivize health care providers to continue this option for patients and caregivers. Indeed, prior to the pandemic, health systems were less enthusiastic about implementing and promoting telehealth services because there was no economic incentive and many regulatory and technical hurdles.
Next, with the reimbursements continuing over the three-year period, we will have the opportunity to collect needed data on telehealth use, accessibility, patient satisfaction, quality outcomes, and the impact on overall health care spending. Finally, limiting the time frame of the law allows us to adapt to how virtual health care evolves. This is a rapidly changing, exciting field. Three years from now there will be interventions that we haven’t yet thought of today. Why would we statutorily tie this innovation to the fee-for-service model of reimbursement that has led to fragmented care and inefficient spending?
Yes, for a short while, we need to continue the reimbursement to establish telehealth as a viable part of the continuum of care. But, longer term, as we push for comprehensive, integrated, and team-based care, we need to be nimble and flexible about how virtual health care fits into accountable reimbursement models.
We can take action now. Current New Jersey law on telehealth requires that a Telehealth Commission be established. This commission could be appointed and assembled and start identifying quality and efficiency measures to use to evaluate telehealth delivery in New Jersey. More details on this suggestion can be found in the consensus-based “Emerging From COVID-19: An Action Plan for a Healthier State” at recommendation eight. Additionally, in the first quarter of 2022, the National Quality Forum’s Action Team on Virtual Health will release a report focused on measuring and advancing high quality, equitable virtual health care. In full disclosure, I serve as a co-chair of this multi-stakeholder group of experts. Those up-coming recommendations will also be valuable to New Jersey as it collects and analyzes its data and determines how best to support telehealth as a means to enhance patient care.
As telehealth continues to evolve and innovate as a mode of care, let’s support and benefit from that growth, not constrain it by the very reimbursement system that we are trying to improve.