Telehealth Use Will Depend on Continuing Pay for Unpaid Provider Work

June 19, 2023 - Published in the American Journal of Accountable Care (AJMC), new research enabled researchers to identify three themes surrounding patient and provider opinions on telehealth costs and reimbursement that influenced virtual care use.

During the COVID-19 pandemic, policies supporting telehealth use led to enhanced access to healthcare. To allow providers to extend and patients to receive virtual care, these changes in legislation provided a financial foundation for services.

Although financial factors influence telehealth success, limited research exists surrounding whether they limit use and adoption. This study aimed to identify the relationships between reimbursement patterns and telehealth engagement among providers and patients.

Researchers included 65 adult patients and 21 primary care providers in the study. These participants came from four medical centers, all of which were part of the National Patient-Centered Clinical Research Consortium Network in New York, North Carolina, and Florida.

All participants engaged in semi-structured interviews to gather information surrounding telehealth experiences and perspectives on financial factors linked to telehealth.

Researchers noted that providers tended to show concern over telehealth reimbursement, while patients seemed to care more about out-of-pocket payments.

Researchers also detailed the three main themes that derived from the in-depth research.

The first theme highlighted how telehealth made uncompensated work more noticeable. Before the COVID-19 pandemic, providers were performing various extra tasks free of compensation, according to the interviews. These tasks included making phone calls for review, changing prescriptions, and simply answering questions. When done through telehealth, these services were billable.

Further, providers shared several recommendations. These included continuing reimbursement models that existed during the pandemic and placing a defined limit on the visit length required to bill.

The second theme was that telehealth reimbursement would play a critical role in determining the fate of this type of care.

Moreover, researchers divided this theme into two parts: the difference between reimbursement for telehealth compared to in-person visits and the sustained use of telehealth.

The former emphasized that there was low reimbursement for synchronous audio-visual telehealth compared to in-person visits at the start of the pandemic. During the public health emergency, changes in policy and payment rates also occurred. This led to dismay among many providers, particularly when reimbursement was low and varied among payers.

The second subtheme highlighted the common opinion among providers that the future of telehealth will largely depend on reimbursement. Many providers noted that insurance coverage had a strong correlation with telehealth use and access. Several patients also noted that telehealth allowed them to reach providers who did not traditionally accept a particular form of insurance.

This leads to the third and final theme, which emphasizes how telehealth alleviates cost issues among patients. Among both insured and uninsured patients, the consensus was that telehealth had lower out-of-pocket costs than in-person care. However, many noted that the length of a follow-up visit should influence its cost.

Many patients also noted that using visit types such as commercial subscription health services rather than in-clinic visits allowed for less costly access to providers virtually.

This research led researchers to conclude that reimbursement will largely influence the future of telehealth use.

Further research surrounding telehealth access and quality for underserved groups should take place as patients indicated lower costs associated with telehealth, researchers added.

Concern over telehealth reimbursement is widespread.

Research from December 2022 indicated that, among other issues, US healthcare executives note that reimbursement serves as a limiting factor for increasing the use of telehealth. In a survey of 38 executives seeking information on telehealth barriers, 26 percent noted that reimbursement was a common issue.

"Telehealth reimbursement is a big barrier," said one chief medical information officer interviewed during the survey. "The reimbursements are okay right now, but we aren't confident they will stay okay after the COVID-19 issues resolve.”