Rand study finds telehealth policy variation limits its use by FQHCs

Telehealth technology that supports consultations between physicians in a hospital and counterparts in underserved communities is not achieving its potential.

A new report from Rand Corporation contents that many safety-net providers still underuse telehealth because of policy, organizational and logistical barriers.

To find answers to addressing barriers, the Office of the Assistant Secretary for Planning and Evaluation within the Department of Health and Human Services funded research carried out by Rand to assess how Medicaid policy influences delivery of telehealth care.

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The study found a huge variation of telehealth policies among the states, as well as Medicare and Medicaid, says Lori Uscher-Pines, a senior policy researcher at Rand.

“Some Medicaid programs allow providers at Federally Qualified Health Centers to provide services at schools and other community sites,” she adds. “Medicaid wants to encourage smart, judicious use, but providers can’t do in-home visits as that leads to higher utilization.”

Further, not all Medicaid policies explain how telehealth will work for FQHCs, leaving stakeholders confused about the rules.

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For now, Medicare reimburses for telehealth only if the healthcare setting is in a rural area, but Uscher-Pines notes that Medicare is starting to chip away at its restrictions and is likely to become more supportive of telehealth services.

A nice feature of telehealth is that it can sometimes be used as a short-term strategy to bridge a gap in care, such as a provider leaving a practice—telehealth can be used to fill the gap until another provider is on board. “This is one way of addressing workforce shortages, but it’s only a partial solution,” she adds.

In developing Rand’s report, the organization had discussions with officials representing seven state Medicaid programs, and with providers and health center leaders representing 19 Federally Qualified Health Centers in those states.

“The telehealth policies of the seven state Medicaid programs in our sample varied across numerous dimensions,” Rand researchers noted.

For example, four of the Medicaid programs reimburse for store-and-forward telehealth, and two reimburse for remote patient monitoring.

Four programs had patient informed consent requirements and three required telehealth presenters to be present with patients at originating sites. In addition, two programs restricted the types of specialists or services that can be provided by telehealth, and five provided a transmission and/or facility fee to eligible originating sites.

Again, however, confusing policies represent a challenge to providers who want to adopt telehealth but don’t really know what the rules are, researchers contend.

“Participants highlighted several weaknesses of Medicaid policies in one or more states, including general lack of clarity on which services were allowed by the Medicaid program, ambiguity around telepresenter requirements, lack of authorization for FQHCs to serve as distant sites in the federal Medicaid program and in select state Medicaid programs, and insufficient reimbursement.”

Rand researchers offer several ideas for policymakers, insurers and FQHCs to consider. They include:

* Authorizing FQHCs to serve as both originating and distant sites may spur the growth of telehealth in the safety net.

* Providing FQHCs and their partners additional clarification of telehealth policies, especially as they relate to FQHCs and education regarding these policies.

* Implementing telehealth as part of a suite of strategies to address workforce shortages in rural areas.

* Educating FQHCs with examples of profitable telehealth programs.

Telehealth services can be implemented as a short-term or long-term solution, but program duration is seldom addressed in telehealth policies and practices, researchers found. Future research should inventory telehealth policies specific to FQHCs and explore relationships between policies and implementation of telehealth by FQHCs.

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