To Avoid Falling Off the Telehealth Cliff, Education Needs to be a Priority


The resulting spike in telehealth use exceeded expectations, with an 11,718% increase in remote Medicare visits between March and April 2020.

In the year and a half since COVID-19 first struck American shores, telehealth has become a vital lifeline for tens of millions of patients who may not have received health care otherwise.

Early in the pandemic, regulators at the Centers for Medicare and Medicaid Services (CMS) realized that telehealth would play a vital role in the crisis. The agency used the national declaration of a public health emergency (PHE) to allow providers flexibility with the technologies they used, the patients they could care for, and the services they could deliver.

The resulting spike in telehealth use exceeded expectations, with an 11,718% increase in remote Medicare visits between March and April 2020.

Telehealth visits for primary and specialty care have since leveled off, now comprising between 15 and 20% of all visits. This is still a significantly higher rate than before. Virtual behavioral health visits, meanwhile, have stayed in the stratosphere with nearly 70% of visits conducted through phone calls or video chats, according to recent data from The Chartis Group.

Both patients and providers are seeing high satisfaction and positive outcomes from engaging in online relationships. A recent Harris Poll found that close to two-thirds of patients would like to continue using telehealth in some form after the pandemic. Meanwhile, the vast majority of providers responding to a Mayo Clinic survey said telehealth enables them to deliver high-quality care, produces better outcomes, and increases their job satisfaction.

But there’s a problem up ahead. While CMS has been able to extend regulatory flexibilities several times under the continuation of the national public health emergency, the agency lacks the statutory power to permanently influence telehealth rules outside of designated rural areas, former Administrator Seema Verma explained in December of 2020.

As a result, the healthcare system is now facing a “telehealth cliff,” or the sudden reinstatement of pre-COVID restrictions in vast areas of the country that have come to rely on virtual care for safe, effective treatment.

If we tumble over this cliff, providers will have to scale back telehealth services and discontinue serving many patients at home. Clinicians who have relationships with patients across state lines will once again be required to navigate complex licensing rules or cease to serve those patients. Millions of patients will potentially lose newfound access to primary and behavioral healthcare.

And reimbursements for most Medicare services allowable under the PHE will dry up, making it impossible for providers to sustain the revenue streams that have kept their doors open throughout the pandemic.

Congressional action will be critical, but it is not the only solution. Education can (and should) play important role in helping sustain the progress we have made.

One of the biggest questions that both policymakers and payers are considering as they assess what services should be covered, for whom, and at what rate, is whether telehealth provides quality care that delivers outcomes as good as in-person care. This is where telehealth education and comes into play. To ensure consistent, high-quality virtual care across hospitals and physician groups, we need a stronger focus on education and industry-recognized certificate programs.

At this key moment in the evolution of telehealth, education plays an essential role in establishing trust and confidence in telehealth knowledge and skills. It will allow primary care physicians, nurses, behavioral health providers – whatever the practice focus – to determine when virtual care makes sense, and when a patient should be seen in person. Training and education will also provide the system skills necessary for providers to understand how they can seamlessly integrate the two together in a sustainable way, which is key to long term success of telehealth.

Certificates are more than a mark of achievement; they also provide payors with important verification and validation of training – demonstrating providers and organizations have an assured and consistent skillset. This matters a lot, not only for providing equal access to quality care, but also when you consider billing and reimbursements. Payers need to understand there is a practice standard in telemedicine, just like there is in traditional office visits. Certificate programs help establish that foundation.

We at the American Board of Telehealth believe education can open a new chapter in the history of telehealth by bringing new levels of quality, patient satisfaction and better outcomes for patients. We are hopeful that healthcare organizations will take the necessary steps to stop us from falling over the telehealth cliff by making telehealth education and training a best practice. Telehealth needs to be woven into the DNA of our healthcare ecosystem, and it starts with what our providers learn.

Mandy Bell is the Innovation Officer at Avel eCARE Telemedicine in Sioux Falls

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