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Why some states are rolling back telehealth access

Teladoc, a rolling telehealth cart that allows physicians to meet with their patients remotely, is shown at Stony Brook University Hospital on Oct. 9, 2021.  (John Paraskevas/Newsday RM via Getty Images)
Teladoc, a rolling telehealth cart that allows physicians to meet with their patients remotely, is shown at Stony Brook University Hospital on Oct. 9, 2021. (John Paraskevas/Newsday RM via Getty Images)

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The COVID pandemic paved the way for widespread use of telehealth doctor’s appointments.

Telehealth appointments worked. So why are some states rolling back access?

"There’s concern of overutilization. It’s like, 'Oh if we allow telehealth to be an option here, everybody’s going to use it. And we’re just going to see way more expense,'" Mei Kwong, executive director at the Center for Connected Health Policy, says.

Today, On Point: How telehealth surged and then stalled.


Mei Kwong, executive director at the Center for Connected Health Policy. (@CCHPCA)

Dr. Leslie Eiland, endocrinologist. Medical director of telehealth and medical director of patient experience at Nebraska Medicine.

Read: Email Q&A with Robert Bell, head of the Nebraska Insurance Federation

Blue Cross Blue Shield Nebraska declined our request for an interview.

Does the Nebraska Insurance Federation support LB256, which would require private insurers to reimburse providers for any telehealth service at least at the same rate as a comparable in-person health visit? Why or why not?

Robert Bell: "The Nebraska Insurance Federation opposes LB 256 as drafted. The bill prevents health insurers from reimbursing providers at a higher rate for a higher level of care provided during an in-person visit. The result will be higher premiums and, for many, higher out of pocket costs for telehealth care.

"Also, insurers are concerned about the possibility that telehealth payment parity will lead to a further concentration of medical providers in urban areas. Instead, insurers prefer the flexibility to continue to negotiate telehealth rates separately."

What concerns does the Nebraska Insurance Federation have about reimbursing providers for telehealth visits at the same rate as comparable in-person visits?

Robert Bell: "As drafted, LB256 assumes that all telehealth services provide the same level and quality of care as an in-person office visit. This may be true in some situations but not in all situations. This is why insurers may elect to provide telehealth reimbursement at parity with in-person visits, limit parity to only some telehealth services, or elect to reimburse more for in-person visits."

I’ve read some insurers are concerned about overutilization of telehealth leading to increased costs. Could you point to some evidence of telehealth being overused?

Robert Bell: "The Federation has not made this argument so I cannot respond."

How does the Nebraska Insurance Federation respond to the argument that increased telehealth could save insurers money in the long run by offering a way for some patients to more conveniently access routine check-ups?

Robert Bell: "Telehealth is a valuable tool for health providers and consumers and in some situations may provide savings. Nebraska insurers welcome savings for their members, but we do not believe a payment parity mandate will result in savings.

"Again, some health insurers may choose to pay telehealth services at parity while others may wish to incentivize in-person office visits. The Federation looks forward to working with policymakers on lowering costs for health care for all Nebraskans."

Listen: Listeners on how telehealth has shaped their care

Alyssa in Madison, Wisconsin, left us a message in the On Point VoxPop app. She says that six weeks after she gave birth to her daughter, she began experiencing postpartum depression, anxiety and severe panic attacks.

"I had my six-week postpartum doctor appointment in person, and they referred me to mental health services. But within a few weeks, I had stopped eating and I couldn’t get out of bed. My parents temporarily moved in with my husband and me to help care for our daughter and ultimately help care for me. I was experiencing suicidal thoughts.

"And at that point, I began weekly telehealth appointments with my primary care provider in combination with twice-weekly appointments with my therapist. I am through the worst of it now but I really, really, mean it when I say that telehealth visits with my doctor likely saved my life. When I was at the depths of my depression and I couldn’t eat, couldn’t shower, couldn’t get out of bed, driving to a doctor’s appointment would have been an impossible hurdle."

Wes in Santa Cruz, California is skeptical of telehealth. He says it seems too expensive for the quality of care received. 

"I work for a small district, and I have a high deductible PPO, which translates into significant out of pocket health care expenses. The idea that a five-minute visit over the phone for Zoom would cost 500 or more dollars is absurd. It's another clear example that our capitalist health care system is broken for patients.

"The corporation's benefit ... doctors ... charge astronomical premiums. The lack of specialists, dermatology in this case, forces providers to use telemedicine. It feels like a scam. How can a skin doctor or other specialist prescribe remedies over the phone?"

Kevin is a gastroenterologist in Harrisburg, Pennsylvania. He says in his region, telehealth’s popularity is waning, partly because doctors aren’t getting equally reimbursed.

"The payment has gone away, and people are now coming back to the offices, so it’s really not used much in our area any longer. There were some electronic glitches from time to time, either on our end or on the patient’s end, but otherwise I thought the process went very smoothly. One last thing I’ll say, in many states, if you don’t have a state license where the patient is located, I cannot give medical advice or charge for telehealth."

Loretta lives in Atlanta, Georgia and has multiple sclerosis, or MS. It’s a chronic disease of the central nervous system.

Loretta and her husband Warren, who’s also her caregiver, say that before telehealth was widespread, they used to have to take hours out of their day to drive to her doctor’s appointments in person. Loretta uses a wheelchair, so the process was not an easy one.

LORETTA: 30% of MS patients have pain.

WARREN: And you’re one of them. (Laughs).

LORETTA: Yeah, I’m the one with the pain, right. So sitting in the car, I need to elevate my legs.

WARREN: Yeah, there’s a, I call it a dance we have to do to try to get Loretta from point A to point B with as little discomfort and pain as possible. You know, the transfer of her from the wheelchair to the stair chair to the vehicle, the drive down to Shepherd Center which is anywhere from 45 minutes to an hour.

Waiting a half hour in advance of the appointment, then going to the appointment, and then getting her back to the home with possible traffic and everything else. The whole process would take minimum of three hours. The beauty of the telehealth is while I might help her set up the appointment, occasionally I’ll sit in, it’s when the appointment begins and usually 30 minutes later, it’s over.

LORETTA: It just made my life much easier.

Interview Highlights

On telehealth before the pandemic

Mei Kwong: "Before the pandemic, telehealth was being utilized, but it was a fairly niche area of the health care delivery system while it was being used, and it's been in use for decades, it was pretty, pretty limited. And that's partly due to in years past because the technology may not have developed to the point where people were comfortable using it. That changed over the last couple of years, because technology has evolved pretty rapidly. But other reasons were the policy landscape itself didn't really encourage the use of telehealth. And by that I mean what you touched upon in your introduction, that there may be limitations on what would have been covered if you use telehealth and limitations on what would have been paid for if telehealth was used to deliver service."

On telehealth during the pandemic

Mei Kwong: "It definitely was a significant change. Tsunami may not be an exaggeration on that. I remember when the pandemic was first declared and all first started, there was this almost immediate pivot not only by health care systems, but you had governments that had to pivot as well, because as I said earlier, the policy landscape was really not set up for telehealth to be used widely. There were limitations on it. So you had governments both on the federal and state level that had to shift immediately and make, at the very least temporary changes to allow telehealth to be used more widely.

"So first you have that level of governments needing to change the policies to allow it to be used. Then you had all these health care providers who either didn't use it before or used it in a very limited fashion, who suddenly had to implement it within within their organizations in order to provide services to the patients. And then you had to educate this wide the general population, not, hey, here's another way yet you can receive services. And that probably was one of the more difficult aspects. It's like changing somebody what they're used to and how they receive health care services.

"We're all used to going to a brick-and-mortar location to receive our health care and suddenly being told, No, you can do it now over your laptop, over video. Or, Oh, we can do it over the file. That required a significant shift for most of the population to only learn about it as a work telehealth research center. And that means we field calls for people who have questions around primary telehealth policy or telehealth in general.

"And usually, they come from health care providers, like, where do I get started? What does this law mean to me, etc., or lawmakers or health plans. But when the pandemic started, we saw an influx of just everyday consumers. Everyday patients say, What is this, telehealth? How can I access it? So there was that definite sort of lack of awareness and education for the general public, and they really needed to be rapidly brought up to speed. So there was a lot of levels where there were a lot of changes needed made."

Dr. Leslie Eiland: "I think there's now a large amount of high-quality data over the last three years showing that outcomes when people are seen via telehealth over in-person care are very similar and patients do well when they get to make the choice in how they receive that care."

What does the evidence show about how well telehealth works or how effective it is?

Mei Kwong: "There's very strong evidence to show that is effective and that it works. Now, you know ... it is going to differ from case to case in patient [to] patient. You may have two patients who present with the same condition, but for whatever reason, one patient might be better suited to using telehealth, and the other one may not be, for a variety of reasons. Really when we look at policy for telehealth, what you probably hear from the majority of telehealth advocates is that we're not asking for telehealth to be able to be used for every single case because it's not going to be appropriate for every single case.

"But we want the ability there for the provider, along with the patient, to decide when it's best to use telehealth or when it's appropriate to use telehealth, because they are the two parties in that particular situation who have the most information to make that decision and not have policies that limit them to just like these very sort of narrow scenarios in which they can use telehealth when it can be used more widely."

On how to keep telehealth available for patients

Mei Kwong: "Definitely the policies need to change. And one of the biggest sort of pushes are drivers for that. That, I think, will help often on the state level is depending on what the federal government does with Medicare. So a lot of times states may follow policies around telehealth that the feds do for Medicare and commercial payers as well. So if the federal government leads with Medicare and making it more accessible that way, we may see more openness on the state level and with commercial payers, too."

This program aired on March 31, 2023.


Claire Donnelly Producer, On Point
Claire Donnelly is a producer at On Point.


Meghna Chakrabarti Host, On Point
Meghna Chakrabarti is the host of On Point.



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