COVID-19 is shining a bright light on the benefits of telehealth. Yet, as this happens, some are pushing payment and coverage mandates that will have large, unintended, long-term consequences on affordability for patients. Instead states and the federal government should set robust frameworks for telehealth that allow providers to use telehealth without barriers across state lines, all without the mandates.
A note on terms before moving forward:
Coverage parity often mandates that all services that can be made available over telehealth must be covered. At times, some coverage mandates will include limiting guardrails such that if an insurer had rules around coverage for that service in-person, those rules can still apply for telehealth. For example, requiring prior authorization for services over telehealth that would have required the same if provided in-person.
Payment parity mandates that telehealth services are paid at the same rate as in-person office visits, often including facility fees.
Not All Telehealth Is Created Equal—Protect Flexibility
A comprehensive research review by MedPAC in 2018 found that telehealth can be a game changer for post stroke care, and for treatments for physically disabling and treatment-intensive conditions. Yet for other services the evidence of better outcomes is far less certain. This is not to say that only services that have proven track records should be covered, but insurers, employers and publicly funded programs should have a choice in what they cover, to try new innovative models to learn what works best for less, but not be mandated to cover all services even if some return no value.
Wasteful spending is estimated to be around 25 percent of current health care spending, or up to $935 billion a year. Many of the sources of wasteful spending (i.e. over-treatment, pricing failures, fraud) could be abused with the convenience of telehealth, especially if those paying the bills are mandated to do so.
This matters as patient health tools have shown that upwards of 50 percent of telehealth visits could be avoided altogether as medical assistance that is less intensive or costly is more appropriate. Wasteful practices become increasingly common under telehealth and mandates make them even more lucrative increasing their frequency.
Parity Drives Up Utilization
A study of claims from states that have passed parity laws has shown that it increases utilization.
While at first glance increasing utilization may sounds like a good outcome, it becomes less laudable if money is being spent on services that don’t add value (see point above). It also can become concerning if paired with payment parity (see below) then spending spikes.
Table 1 compares telehealth claims data from 2010-2015 in parity state vs. non-parity states….