COVID-19 has resulted in a wave of telehealth policy reforms at the federal and state levels across the country. One regulatory reform, in particular, has gotten a lot of attention and support from industry stakeholders and lawmakers alike: expanding audio-only telehealth services. This time-proven technology can be used to address major gaps in care access, particularly among large portions of the population who are disproportionately low-income and underserved with limited or no broadband internet access to support video connections.
Earlier this year, a group of health policy professionals attended the Society of Health Policy Young Professionals‘ Telehealth Summit, which brought providers and researchers together to explore long-term policies that would allow healthcare workers to meet consumers where they are. Offering audio-only telehealth services beyond the public health emergency (PHE) emerged as an apparent option throughout this discussion.
Inequities in Broadband and Audio-Only Telehealth
Audio-only visits have been a savior for patients who have been unable to attend in-person consultations or engage in telehealth video visits due to a lack of broadband connectivity or essential equipment to facilitate the visits during COVID-19. According to the former administrator of the Centers for Medicare & Medicaid Services (CMS), during the PHE, almost 3 million people received telehealth services over the phone, and the majority of phone visits were for mental health concerns.
President Joe Biden’s administration has made significant strides to overcome the connectivity divide. Meanwhile, many lawmakers have proposed legislation that would cover virtual healthcare without a video component. Some of TBHI’s previous articles about audio-only telehealth services are below:
- Telehealth in Rural Areas: Bill to Expand Telehealth
- Telephone Telehealth Safety Procedures for Professionals
Reimbursement and Expansion of Audio-only Telehealth Coverage
Prior to the pandemic, audio-only telehealth was seldom reimbursed, and only three states mandated audio-only coverage. As of spring 2021, Medicaid programs of 15 states allow audio-only telehealth delivery, and 26 allow reimbursement services due to the expansion of federal regulatory flexibilities. More recently, CMS proposed expanding Medicare coverage to audio-only communication technology for telehealth services to diagnose, evaluate, or treat established patients with mental health and substance abuse disorders. The CMS proposal also includes Medicare coverage for telemental health services for beneficiaries that are unable to leave their homes for appointments.
The Primary Motives Behind Audio-only Telehealth Services
This CMS proposal is gaining support from key players. Senator Patrick Kennedy (RI) and Senator John Sununu (NH) described telephone telehealth as being a “lifeline” for nurses. Ensuring the availability of audio-only telehealth service is considered necessary by many parties for the following reasons:
- A high-speed internet connection and broadband services are required for video telehealth. About a third of Native Americans in the United States live on tribal lands, where suicide and incest are more common, and treatment for substance abuse disorders is difficult to find. Audio-only telehealth access is cost-effective and assures the availability of healthcare even without high-speed connectivity.
- Digital literacy is required to use video healthcare services. The Bipartisan Policy Center recently collaborated with Social Sciences Research Solutions on a consumer survey that found older Americans were more likely to use audio-only health services rather than video visits in the previous year. Overall, 42% of older adults face some kind of technology or access barrier when participating in telehealth video visits. These obstacles are much more severe for the elderly and those who live in rural areas. They are also difficult for family members’ caregivers who may require much time and attention in the home.
In conclusion, Health and Human Services (HHS) will continue to keep an eye on usage trends and enforce consumer protections just as it does for other outpatient services to mitigate the risk of deception and exploitation with telephone-based telehealth services. The use of audio-only health care visits is not a panacea, but rather one of the many technology-based communication tools that can be used for specific types of interventions at various points during the trajectory of a client’s or patient’s healthcare. Audio-only access to physicians will help minimize disparities, particularly in mental health and substance abuse. Regardless of the eagerly anticipated final decisions in reimbursement as yet to be determined at the federal Medicare level, state-based Medicaid and private payer arenas will be determined on a state-by-state basis.
For yet more detailed information about telephone telehealth, see:
- Controversy about Eliminating Telephone Telehealth Coverage
- COVID-19 Telephone Telehealth Reimbursement
Telehealth Video & Telephone Best Practices
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