At the forefront of advocating for telehealth-based patient care delivery, the Arlington, Va.-based American Telemedicine Association (ATA) has been in the advocacy and communication trenches since it was formed in 1993. And the ATA was front and center last year, as the emergence of the COVID-19 pandemic in the United States in the early spring caused the leaders of patient care organizations nationwide to kick remote care delivery into high gear for the first time.
The ATA’s leaders were prepared for that moment, having spent many years working to make telehealth an accepted—and reimbursed—mode of care delivery here in the United States. As the organization’s website notes, “As the only organization completely focused on accelerating the adoption of telehealth, ATA is working to change the way the world thinks about healthcare. We are committed to ensuring that everyone has access to safe, effective, and appropriate care when and where they need it, enabling the system to do more good for more people. We represent a broad and inclusive member network of technology solution providers and payers, as well as partner organizations and alliances. Together, we are working to advance industry adoption of telehealth and virtual care, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.”
What’s more, in July 2020, the association published its “ATA Policy Principles,” with the following introductory text:
“The policy principles of the ATA are rooted in its vision: we promote a healthcare system where people have access to safe, effective and appropriate care when and where they need it, while enabling clinicians to do more good for more people. To address global challenges driven by rising healthcare costs, an aging population, variation in quality and outcomes, and an inadequate number of clinicians, the ATA advocates using technology to reimagine care and supports policy that ensures all people receive care where and when they need it. To effectively leverage and expand telehealth, digital health, and virtual care technologies, federal and state health policy must be technology, modality, and site-neutral.”
And the principles are as follows:
- Ensure Patient Choice, Access, and Satisfaction. The location of the patient receiving services or the clinician providing them should not be arbitrarily limited by geography and patients should be able to receive high-quality telehealth services anywhere, including the home.
- Enhance Provider Autonomy. Telehealth plays an important role in delivering care across the continuum. Federal and state policy should treat healthcare services delivered remotely no differently than services provided in-person. The modality used to deliver care should be determined by the clinician, in consultation with the patient, and should meet the same standard of care as services provided in person. Telehealth should not be limited to any specific technology provided that it is safe, effective, appropriate, and able to be fully integrated into clinical workflows.
- Expand Reimbursement to Incentivize 21st Century Virtual Care. Federal and state health programs including Medicare and Medicaid should broadly cover and reimburse for all forms of telehealth. Private payers should compensate healthcare providers for delivering remote care. At the same time, a provider and healthcare plan should have the ability to contractually agree to reimbursement rates for telehealth services based on market conditions and value-based payment models. All payers should ensure transparency and clarity when implementing reimbursement policy to reduce burden on healthcare providers.
- Enable Healthcare Delivery Across State Lines. Adoption of interstate licensure compacts, flexibility for professional second opinions, and other related licensure portability policies ensure that clinicians can treat patients safely across state lines. Policy barriers that impose undue administrative burden or restrictions that do not promote patient access, continuity of care, and quality medical services must be avoided. State and federal policy should ensure efficient licensure during public health emergencies.
- Ensure Access to Non-Physician Providers. Healthcare providers at all levels must be able to participate effectively across care teams and leverage telehealth to reach patients where they are. Artificial regulatory barriers on non-physician healthcare providers that do not contribute to quality, patient safety, or improved outcomes are unnecessary impediments to expanding the healthcare workforce, ensuring access to care, and reducing healthcare costs.
- Expand Access for Underserved and At-risk Populations. 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.
- Support Seniors and Expand “Aging in Place”. State and federal policy should ensure seniors have access to high-quality, affordable virtual care wherever they reside. Age-friendly healthcare policy should ensure autonomy and expanded access to seniors and caregivers while ensuring continuity of care.
- Protect Patient Privacy and Mitigate Cybersecurity Risks. Patient privacy, and the protection of patient data, are a prerequisite for connected care. State and federal regulatory schemes should allow for innovation and support the advancement of technology-assisted care; however, telehealth and virtual care platforms, systems, and devices should be required to mitigate cybersecurity risks and provide for patient safety and confidentiality.
- Ensure Program Integrity. Public and private payers and healthcare providers must ensure guardrails are in place to protect patients and ensure program integrity of virtual care programs. Federal and state policies should leverage technology to optimize program integrity measures and prevent fraud and abuse without providers being required to see patients in person.
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Ann Mond Johnson, CEO of the American Telehealth Association, regarding her perspectives on the challenges and opportunities of the current moment. Mond Johnson will be a keynote speaker at the Healthcare Innovation Southeast Summit, to be held in Nashville on Thursday, September 23 and Friday, September 24. Below are excerpts from that interview.
When you look at the current landscape around telehealth in U.S. healthcare right now, what do you see?
As you know, with regard to the ability for people to connect with their providers when in-person contact isn’t necessary or possible, this has been going on for a long time. And, through the pandemic, we’re delivering on what we’ve wanted to deliver on for some time. And some of the rules that prevented broad adoption, were implemented in nineteen ninety-seven, fourteen years before the iPhone was invented. And this is how healthcare can be delivered. And the third thing is that we had really pressing problems with access to care, with where you live defining your healthcare destiny, and the uneven distribution of high-quality care, those issues cannot be addressed without telehealth. There’s an urgency, and now we have an obligation.
There has been this self-fulfilling prophecy of slowness in healthcare, and that was proven to be at least somewhat false last year, as the leaders of patient care organizations were able to ramp up their telehealth capabilities very quickly.
I think that necessity is the mother of invention. And we had urgency, which drove innovation, responsiveness, quick turns of knowledge. Think about the back-and-forth dialogue about the best ways to treat COVID—things in the clinical sphere like putting patients on their stomachs. I think we demonstrated a willingness to collaborate, to innovate, and to turn on a dime. And as it relates to telehealth, there were so many clinicians, so many consumers who had not used it before. But when patients started to get communications from their physicians saying, would you like to talk, even audio-only, it was remarkable what could be accomplished
Do you believe that the flexibilities introduced last March will be permanentized?
Well, from your mouth to God’s ear. We have over four hundred organizations that are members of the ATA,, that represent diverse aspects of this space. So we’re advocating for permanence. So Kyle Zebley, our vice president of public policy, and other colleagues, are advocating in Congress and in the state legislatures; we clearly are hoping for permanence. And what’s interesting is that the average American wasn’t aware of this; and it’s not because we’re stupid, it’s because we just didn’t know better.
Much has been made of consumers’ overwhelmingly positive experience with telehealth, beginning early last spring. It turned out that consumers loved remote care delivery, and still do. Are we finally seeing the long-awaited proof of the empowered healthcare consumer, making empowered choices around what they want and how they want it?
My attraction to joining the ATA—I’ve always been focused on meeting people where they are. This is what telehealth is all about. Americans need access to safe, reliable care wherever they are. And we can’t meet it by having one doctor to one patient; we need other modalities. And I think people understand that. If you’re young and healthy—you know, people just don’t pay attention any longer to healthcare brands. And if you have needs, you want to see your clinician when you need to. What is astonishing is the growing number of people who are insisting on seeing their clinicians remotely, on messaging their physicians. So do I have hope around the growing consumer experience? Yes.
At the same time, if you think about the vision of the ATA and where we’re headed, it involves acknowledging that we had deep-seated issues in healthcare before the pandemic happened, and it’s our obligation to eliminate the disparities and inequities in healthcare. And I’m encouraged because the cost of technology has dropped, and the connectivity has increased and is increasing even more. And finally, there is consensus around this: there is such benefit to all of us if we ensure that all Americans get access to care.
Do you think the policymakers in Washington, D.C. and the state legislatures understand this?
I think so, the fact that Senators Schatz and Scott [Brian Schatz (D) of Hawaii, and Tim Scott (R) of South Carolina] are on board, and understand that we need to eliminate arcane regulations, offers evidence. Certainly yes, at the federal level, they are aware. And yes, you have to ben eternal optimist to be in my seat, and I am that.
Will the higher facility rate of payment be maintained, and should it be?
On the one hand, the changes in reimbursement did help accelerate adoption by clinicians, no question about that. But there is also now a whole cadre of providers that will do this because it’s the best way to reach patients. You see managed care plans like Humana and United doing this, and Kaiser is doing it. So I think that reimbursement is obviously an issue. We don’t get into pricing activities between private parties, nor should we; but we also know that because consumers have benefited from this, it’s going to continue to be a drumbeat. And remote monitoring has really, really accelerated.
When you look at the next five years, what do you see happening on policy and industry levels?
On the industry level, we’re going to see a lot more innovation. Our four-hundred members—we have companies that are providing tech space or interactions that they make available; we have companies doing remote monitoring, decentralized clinical trials, artificial intelligence, virtual reality—so, the definition of telehealth is much broader than it had been historically. And our mission will continue to involve helping Americans understand that this is an essential modality. As it relates to policy, there’s been a tsunami of bills and legislative activity at the federal and state levels. And we’ve been absolutely vigilant about staying on top of that.
Is there anything you’d like to add?
I just think it’s really important for people to understand that we need to get rid of 1834M; we need to do that, including restrictions around the originating site of care. That’s why the Connect Act is so important. It’s a very bipartisan issue; so shame on us if we don’t.
[Per 1834(m), the American Hospital Association published a whitepaper to its website on March 17, 2020, explaining the context of the set of regulatory regulations that the Centers for Medicare & Medicaid Services relaxed during that week:
“Payment for Medicare Telehealth Services. CMS granted an expanded Section 1135 waiver, under which Medicare will pay for office, hospital, and other visits furnished via telehealth across all areas of the country and in all settings, including in patients’ homes, starting March 6, 2020 and for the duration of the COVID-19 public health emergency. This operationalizes the waiver of the originating and geographic site restrictions on telehealth services that are codified in Section 1834(m) of the Social Security Act (the Act). Medicare considers these telehealth services the same as in-person visits and will pay for them at the same rate as regular, in-person visits.
Telehealth flexibilities include:
- Waivers of originating and geographic site restrictions on Medicare telehealth services, permitting the delivery of these services in all areas of the country and all locations, including patients’ homes.
- The ability of providers to use expanded telehealth authority for new and established patients for diagnosis and treatment of COVID19, as well as for conditions unrelated to the pandemic.
- Permission for providers to use everyday communications technologies, such as FaceTime or Skype, during the COVID-19 public health emergency, without running afoul of HIPAA penalties.”