5 Telehealth Takeaways from Former Senator William Frist

ATA policy conference explores the promises and challenges that lie ahead for continued telemedicine growth.

Telehealth is taking center stage at many hospitals, health systems, and physician practice organizations, as a way to permanently transform care delivery. Yet its future could be severely impeded by lack of Congressional action to permanently change regulations that were lifted due to the COVID-19 pandemic.

Against this backdrop, the American Telemedicine Association (ATA) launched its ATA EDGE Policy Conference last week, a month-long series of two-hour sessions that's convening thought leaders, policy makers, and pundits who are influencing the future of care delivery.

Former Tennessee Senator William Frist, MD, who also served as U.S. Senate Majority Leader during his tenure, spoke at last week's conference, outlining some of the key issues involved, as well as actions physician practices should consider to be more fully prepared for the future. Here are key takeaways:

1. The Outlook for Telehealth is Optimistic

"In my 30 -year journey with telemedicine," said Frist, "I have never been more optimistic, more excited about our future as I am today. We are at an inflection point, and inflections bring new challenges … demand changed perspectives, changed understanding, and changed behaviors on our part. [The] scaling of telehealth services that took place across the country over the course of the pandemic has been astounding. The explosion of virtual care, I'd argue, is the single most transformative and most constructive advance to emerge from the COVID-19 crisis. Most importantly, the pandemic has created a seismic shift in the culture of telehealth."

2. Rapid Progress Occurred Because Regulations Were Lift

"I think all of us recognize that this rapid growth was made possible by emergency regulatory measures that speeded access and reimbursement for telehealth services, making physician adoption feasible, removing those traditional bottlenecks and administrative decision-making," Frist said. These included:

• Medicare payment parity—something that many private insurers also adopted
   
• Waiving Medicare geographic restrictions
   
• Expanded Medicaid coverage, including coverage of audio-only care
   
• CMS expanded the list covered providers, enabling an additional 140 categories of providers to provide service via telehealth
   
• Relaxed physician interstate licensure, waving Medicare and Medicaid requirements that practitioners be licensed in the state where they're providing services
   
• Relaxed HIPAA data privacy rules, allowing providers to use non-HIPAA-compliant telehealth platforms like Skype and like FaceTime.
   

3. Telehealth Advocates are Disappointed in Recent Congressional Actions

"I'd hope to see more of these [telehealth] policies included in the year-end spending and COVID-19 relief package," said Frist. Some were added, including increasing funding for the Federal Communication Commission's telehealth work and expansion of broadband, as well as Medicare coverage for telehealth mental health services.

"But I agree with what [ATA CEO] Anne Mond Johnson said, 'The noticeable lack of permanent reform for a guaranteed extension of the telehealth flexibilities in this relief package is disheartening for the millions of Americans who relied on telehealth to access care and our healthcare providers still on the front lines of the pandemic. We believe arbitrary restrictions on telehealth must be permanently removed to make way for a modernized and more accessible healthcare system.' "

Frist also urged, "If we all participate in a continual drumbeat for action, we'll make clear the urgency of making these advances permanent."

4. Potential Bipartisan Support Exists for Future Telehealth Legislation

While the Senate is divided, and therefore vulnerable to filibuster, Frist said there is bipartisan support for some health policies. "Telehealth is unquestionably at the top of that list," he said.

"To continue this progress, we need to permanently allow telehealth access regardless of patient and provider location. We need to codify the broader range of practitioners, such as physical therapists, occupational therapists, speech and language pathologists, and others to provide Medicare telehealth services," he said. Also, coverage for federally qualified health centers and rural health clinics is necessary to support underserved populations. In addition, "Congress must also address cross-state licensing barriers, a more challenging area to navigate and with reimbursement and treat all forms of communication equally if providers can meet and must meet the same standards of care."

5. Physician Practices Need to Prepare for Future of Telehealth

Frist offered five ways physician practices should prepare for the future of telehealth:

• Digital. Frist recommends that physician practices devote 15% of their budgets to a digital backbone. "Capture and claim this tidal wave of coalescence of digital and telemedicine," he said. "This is your opportunity to fill the digital infrastructure gaps in the patient journey. Pre-COVID telemedicine moved at the snail's pace of traditional doctor-patient interactions. That's the past. 2021 and the future will require [physicians to] assimilate with true digital, which moves at the speed of computers."
   
• Integration. While telemedicine was once about automation, today, it's focused on integration of the entire patient experience longitudinally. This could encompass the course of a chronic disease or even the course of a lifetime.
   
• Partner with Health Systems. Health systems are now highly motivated to incorporate telemedicine and "intelligently orchestrate the digital demand and health system capacity across all lines of care using virtual health telemedicine to do so," Frist said. Physicians must actively insert themselves in that process and "claim the ground" and "be in an inextricable part of the solution" which will offer true value-based care and partner with new care delivery models. 2021 will bring an explosion in the variety of new care delivery models aimed toward care delivered in patients' homes, he said.
   
• Interoperability. "Align yourself with the interoperability," Frist said. Digital data "moves at the pace of computers" and is instantaneously accessible and shareable in the virtual space. He suggested devoting resources to interoperable information technology, machine learning, and big data to create a seamless experience.
   
• Engagement. "We can make diagnoses, we can monitor, and we can treat, but if we don't engage the patient over time, the diagnosis and the short-term treatment really means nothing," said Frist. "Telemedicine must move beyond just a physician on a video or a nurse on the phone. Otherwise we are just a commodity and the world will treat us as a commodity."