This week, the co-chairs of the Committee on Ways and Means’ Rural and Urban Underserved Taskforce—Congresswoman Terri A. Sewell (D-AL), Congressman Brad Wenstrup (R-OH), Congressman Jodey Arrington (R-TX), and Ways and Means Worker and Family Support Subcommittee Chairman Danny K. Davis (D-IL)— invited several thought leaders to participate in a Member-driven virtual roundtable to discuss telehealth.
The roundtable, “Examining the Role of Telehealth during COVID-19 and Beyond,” featured the testimony of a diverse group of practitioners and highlighted the vast changes to the telehealth landscape during the COVID-19 pandemic.
“When I think about how we measure telehealth success, I think about the most remote area of my congressional district, where there is one doctor in the county and residents have to travel an hour or more to the nearest hospital and farther for specialty care,” said Rep. Sewell. “When the residents of that county can access the best practitioners via a telehealth appointment when it’s clinically appropriate, that’s when we will know that we’ve met our goals when it comes to telehealth. That’s my goalpost.”
“Community Health Centers which serve more than 28 million low-income and disproportionately uninsured patients in rural and underserved urban areas of the United States have not fared well during the pandemic, with significant drops in ambulatory visits, which have resulted in furloughs, layoffs, and more than 1,900 temporary site closures throughout the country,” said Chairman Davis. “Community Health Centers not using telehealth report the following barriers: 36 percent cited lack of reimbursement, 23 percent lacked funding for equipment, and 21 percent lacked training for providing telehealth. More rural than urban clinics reported inadequate broadband services. Forty-one percent of Medicare beneficiaries lacked access to a computer with high speed internet access at home. A similar number did not have a smart phone with a wireless data plan, 25 percent did not have either option. The proportion of Medicare beneficiaries with digital access is lower among people who were 85 or older, widowed, had a high school education or less, were Black or Hispanic, received Medicaid, or were disabled.”
“As we’ve faced this pandemic, my constituents in rural Ohio have had access to a key lifeline by being been able to connect to their doctor from their own home,” said Dr. Wenstrup. “That’s why my Republican colleagues and I released a discussion draft as a start to the conversation on where telehealth legislation should go to make these new flexibilities permanent. However, we need to be smart about how we make these flexibilities permanent so we can protect American taxpayer dollars.”
“There’s nothing quite like technology in health care that meets all three of the key objectives of quality, access and costs. We’re going to overcome [COVID] as a nation, and we are going to do it together. But one of the silver linings is that we are pushing technology— and the utility of technology— to a place where we can maximize its impact,” said Rep. Arrington.
Members and participating panelists discussed opportunities and challenges associated with making permanent some of the current telehealth flexibilities, implementing more value-based payment, including alternative payment models, replacing arbitrary utilization controls, such as limitations on originating sites, with smarter program integrity initiatives, addressing infrastructure issues, like the lack of broadband in many parts of the country, and ensuring telehealth is used in ways that improve health outcomes rather than create more layers of health inequity for rural and underserved communities.
This panel is intended to be the first of several roundtables that will provide an opportunity for the Task Force to discuss their top four policy areas of focus:
- Addressing direct social determinants of health;
- Enacting payment system reforms;
- Strengthening technology and infrastructure; and,
- Reinforcing our workforce.
In addition to the co-chairs, the following Members participated in the round table: Adrian Smith (R-NE); Mike Thompson (D-CA); Mike Kelly (R-PA); Gwen Moore (D-WI); Jason Smith (R-MO); Judy Chu (D-CA); Tom Rice (R-SC); Dan Kildee (D-MI); Don Beyer (D-VA); Ron Estes (R-KS); Tom Suozzi (D-NY); and Steven Horsford (D-NV).