Telehealth uses communications technology to deliver health care, health information, and health education at a distance. Telehealth is a more universal term for the current array of services provided. Another term, telemedicine, typically refers only to physician services. These services can also be used in long-term services and supports and home- and community-based services settings. Examples of services include remote patient monitoring and live video interactions with health care providers.
While telehealth services are expanding rapidly in many states, a number of factors limit their ability to reach beneficiaries. Lack of high-speed broadband service in many sparsely populated areas and the inability of clinicians in some states to work across state lines are two common barriers. In addition, Medicare limits payment for telehealth services to services provided in a clinical office and by a specialist.
Services provided by telehealth have great potential to help consumers more easily connect with various health care clinicians, maintain their quality of life, and remain in their communities longer by providing an opportunity to manage their care. Telehealth gives people the ability to schedule health-related appointments and request prescription refills. It can remind them to take medications and serve as a method to link to a health care provider when time or distance is a barrier. Telehealth can also support family caregivers’ efforts to care for their loved ones.
Approximately 84 million Americans live in officially designated primary care health professional shortage areas. Experts observe that the disparity in incomes between primary care physicians and specialists discourages medical school graduates from choosing primary care careers. To help address this problem, the ACA mandated a 10 percent Medicare bonus payment for primary care services from January 1, 2011, through December 31, 2015.
Telehealth uses telecommunications technology to deliver health care, health information, or health education at a distance. It could help alleviate workforce shortages and health care access issues. (For more on telehealth in Medicare, see also the section on Medicare in this chapter.)
Services provided by telehealth have great potential to help consumers more easily connect with various health care clinicians, maintain their quality of life, and remain in their communities longer by providing an opportunity to manage their care. Telehealth gives people the ability to schedule health-related appointments and request prescription refills. It can remind them to take medications and serve as a method to link to a health care provider when time or distance is a barrier. Telehealth can also support family caregivers’ efforts to take care of their loved ones.
Telehealth encompasses four distinct applications:
- Live video (synchronous): This is a live, two-way interaction between a provider and a patient, caregiver, or another provider using audiovisual telecommunications technology.
- Store-and-forward (asynchronous): Recorded health history (for example, pre-recorded videos and digital images such as x-rays and photos) is transmitted through a secure electronic communications system to a practitioner.
- Remote patient monitoring (also known as RPM): Personal health and medical data is collected from an individual in one location via electronic communication technologies and is then transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support.
- Mobile health (also mHealth): Health care and public-health practice and education is supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants.
Federal and state governments should encourage coverage and payment of telehealth services for eligible beneficiaries to improve access and the quality of care. This should include eliminating unnecessary restrictions that limit beneficiary access. Doing so would allow patients to remain safely in the community and assist with care transitions from institutional to community settings.
Audio-only appointments and remote patient monitoring should be covered to ensure broad patient access, while continuing to promote broad access to virtual video appointments.
Federal and state policymakers should remove geographic restrictions on coverage for telehealth services.
States should adopt interstate licensure compacts for physicians, Advanced Practice Registered Nurses, registered nurses, and other licensed health professionals. It would expand provider networks and reduce interstate barriers to telehealth services.
Federal and state policymakers and the private sector should provide funding to ensure that households with low and moderate incomes can afford high-speed internet service and equipment for telehealth services/ This is critical during a public-health emergency. As evidenced by applications, interest in such service has far exceeded available funding for the Federal Communication Commission’s Pilot Telehealth Program.
Federal and state policymakers should facilitate the adoption of appropriate telehealth services by providers serving underserved populations. This includes pilot programs like the Federal Communication Commission's 2020 pilot telehealth program. Policymakers should analyze the results of any pilot programs to inform future policymaking.
Services provided by telehealth should offer quality and ensure that patient-related records and communications are protected from fraud (see this chapter’s sections on Quality Improvement in Medicare and Privacy, Confidentiality, and Security of Health Information).
Telehealth clinicians should be required to follow all standards of care and regulations appropriate to their profession and inform patients of their credentials.
Policymakers should ensure that individuals have access to the technologies that enable telehealth (see also High-Speed Internet Services). The mode of care provided to the individual should align with the preferences of the person and their family caregiver and be appropriate to meet their needs.
Payment for telehealth
Payment for telehealth services should be sufficient to incentivize telehealth use by providers and raise value for patients.
Public and private payers should thoughtfully consider how to reimburse clinicians and other telehealth providers. This includes accounting for the cost of providing telehealth, the need to support patients’ ongoing access to telehealth with compensation that fairly rewards its use, the need to avoid unnecessary additional costs, and the efficiencies telehealth may afford.