How Telehealth Can Address Inequities in US Healthcare

This year has been trying for our nation.  Our unprecedented response to COVID-19 has impacted every aspect of our lives, including how we deliver care to our citizens.  Out of this great test, telehealth has undoubtably been one of the few bright spots, stepping into the breach and helping save our healthcare system from collapse by providing quality care to patients where and when they need it. As we have learned during this public health emergency, telehealth is a perfect option for non-emergency medical events, keeping individuals and our frontline healthcare providers safe from further transmission of the virus.

COVID-19 also brought to the nation’s attention inequities in health that existed prior to, but were exacerbated by, the pandemic. Proponents of telehealth, and the millions of patients and providers who have seen its value and do not want to lose it as a modality of care, are pushing policymakers to maintain the regulatory flexibilities and a sufficient level of reimbursement following the pandemic. This is important because telehealth can not only extend access to care for all Americans but also play a vital role in reducing systemic health inequities. Telehealth did not cause these inequities but can be part of the solution.

Telehealth has been able to shine during this crisis and do what many of us have long known it’s capable of because both state and federal governments lifted existing regulatory barriers and stepped up reimbursement to make telehealth available for millions of Americans for the first time.  These changes, however, are not permanent and have largely been contingent on the ongoing public health emergency.  Policymakers must realize that our healthcare system will not be able to care for millions of vulnerable and underserved Americans without having telehealth as an option.

Our care delivery system was facing several critical challenges before the pandemic that will reemerge following the pandemic if policymakers don’t responsibly act now.

First, the United States has a severe physician and healthcare worker shortage coupled with a rapidly growing aging population.  A recent report from the Association of American Medical Colleges (AAMC) predicts a shortfall of up to 139,000 physicians by 2033.  Telehealth is a means to effectively maximize a limited healthcare workforce.

Next, rural Americans must travel long distances for treatment, compounded by the fact that many hospital systems are closing, which has been exacerbated by COVID-19.  According to data from the Sheps Center, more than 170 rural hospitals have closed nationwide since 2005.  By offering access to care to patients in their own home, telehealth is part of the solution to healthcare challenges facing rural America.

Finally, too many Americans who lack access to care for financial reasons use emergency rooms as an option of last resort.  This is the most expensive variety of care available.  Ascension Health found that from March to May 2020 nearly 60% of Ascension patients would have sought more costly care at either an urgent care facility or hospital emergency room had they not had access to virtual care.

Greater access to care, better utilization of healthcare services, and reduced healthcare spending via telehealth can help extend quality healthcare to more Americans, no matter where they live.

The American Telemedicine Association’s policy principles note that “underserved rural and urban communities, tribal nations, and the uninsured must equally benefit from telehealth and digital health services. Health disparities should be addressed and reflected in state and federal health programs and policy makers must support robust investment in telehealth infrastructure, including broadband, to ensure universal access for the benefit of all communities.”  To make this vision a reality, policymakers in Washington, D.C., and across the nation should consider taking commonsense steps immediately, including:

• Congress should address the current statutory restrictions on patient geography and originating site limitations.
• State legislatures should act to ensure Medicaid fully covers telehealth services and that a patient and provider can establish a relationship through telehealth.
• Broadband expansion should be a top priority for both federal and state governments.
• And finally, federal and private health insurance plans should compensate healthcare providers for services delivered via telehealth at a fair payment rate that also takes into consideration the ongoing investment necessary to ensure these telehealth platforms are continuously maintained, seamlessly updated, and can continue to expand as needed.

If these steps are taken, we will have come a long way as a nation towards ensuring all Americans, especially those who have historically lacked access to care for social or racial reasons, have better health outcomes moving forward.

About the Author
Senator William Frist, MD, is a nationally recognized heart and lung transplant surgeon, former U.S. Senate Majority Leader, founding partner of Frist Cressey Ventures and chairman of the Executives Council of the health service investment firm Cressey & Company. He is actively engaged in the business as well as the medical, humanitarian, and philanthropic communities. 

Editors Note: Senator William Frist, a physician, businessman and former U.S. Senate Majority Leader, will discuss telehealth’s pivotal role in care delivery during the pandemic, implications from the election and the policy and regulatory actions needed to make telehealth part of the ‘new normal’ in healthcare delivery during the ATA EDGE Policy Conference on Tuesday, January 12, 2021 at 11:10am ET. Registration is open.