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It’s no secret that telehealth and telemedicine will expand in 2020, with doctors closing offices and sheltering patients in place to curb the spread of Covid-19.
But telehealth advocates were calling for policy and legal changes years before the outbreak, and that work continues now.
The American Telemedicine Association (ATA) and its advocacy charity ATA Action are now supporting the Creating Opportunities for Necessary and Effective Care Technologies, or versions of the 2023 Health Act, pending in the US Senate and House of Representatives. It spurs a continuing national conversation about the best ways physicians can use improved communication technology to treat patients.
Kyle Zebly
American Telemedicine Association
ATA Senior Vice President of Public Policy and Executive Director of ATA Action Kyle Zebley Medical economics To discuss the latest, current landscape and future opportunities of telemedicine in Congress and in practice.
This interview has been edited for length and clarity.
Medical Economics: Can you describe the telehealth landscape now?
Kyle Zeble: As trying and difficult as the COVID-19 pandemic has been for the American people and people around the world, telehealth is widely recognized as one of the silver linings of the pandemic. As an industry, we have seen tremendous growth in the use of telehealth during the pandemic. We have become a permanent part of the US health care system. If people didn’t know much about telehealth before the pandemic, now we’re in a position where patients, providers, policy makers, the public at large are all very aware, aware, and supportive of telehealth. Most Americans have now had some interaction with telehealth and so we are still in very rapid growth. We are looking to build on the gains we made during the pandemic and ensure that the level of accessibility achieved over the past few years is not reversed. But this continues to be an exciting time for the telehealth community three and a half years after the outbreak began.
Medical Economics: What is the most important provision for physicians in the 2023 CONNECT for Health Act? What is the most important provision for patients in this version of the law?
Kyle Zeble: I would say it’s the same answer or answers for both providers and patients. One of the best features of this great piece of legislation is that it makes the dynamics of the pandemic permanent. That means patients can get care from Medicare providers regardless of their geographic location and location of origin. Before the outbreak, under existing law, you had to be in a certain rural area outside of a metropolitan area, and within the four walls of a provider’s office to receive telehealth services. Obviously, the technology has long since passed those outdated offerings, but that’s where we were before the outbreak. CONNECT for Health Act will permanently remove those geographical origin site barriers. Likewise, to move forward according to the current law, telemental health care ensures that there is no physical requirement, to ensure that the provision will never see the light of day, which, again, allows full potential. Telemental health in this context. Ensuring that there is no return to pre-pandemic thinking is a key feature of what we see as the CONNECT for Health Act for patients and providers.
Medical Economics: The ATA website is loaded with action letters to various state legislatures considering various telehealth regulations this year alone. How important are government regulations? And are there wide differences between regions?
Kyle Zeble: To answer your first question, how important are state legislatures? Our members who are part of the ATA and others involved in the health care system know very well that as important as the federal framework and as important as the federal rules and regulations, at the end of the day, maybe The aspect of your organization most influenced by government will be the state governments that influence your organization. Here are some questions about what the process is for getting licensed as a medical practitioner, what boards to apply to, what is the standard of care, what is the age of consent, what can you do with controlled substances. As for health care and commercial coverage of telehealth, regulations surrounding Medicaid telehealth coverage are regulated at the federal level by federal regulations, all of which are primarily state-based concerns. And this is the jurisdiction of state legislatures, state regulators. It’s really not an understatement to say that organizations that practice telehealth will live or die directly depending on what happens at the state level.
And to answer the second question, it is important to consider that two states are not the same. No state regulates telehealth the same way as another. Regions vary greatly. Some states have brick and mortar or physical requirements, which we strongly oppose. Some states limit or restrict which technologies and methods they can deploy and which vendors can deploy them. One of the challenges we face ourselves is making sure we’re leveling the playing field for telehealth. We’re not asking for a lower standard, but we shouldn’t hold a higher standard because at the end of the day, telehealth is health, not something separate and distinct. The same standard of care that applies to physical visits also applies to virtual visits. And if they can’t realistically do something, that decision should be made by a licensed medical professional, not a regulator, not a legislator.
Medical Economics: What are some possible ways to integrate artificial intelligence into telemedicine services? Are there risks associated with this? And what are some of the next steps to use in patient care or regulation?
Kyle Zeble: Two things: One, it’s already being used in terms of algorithms to provide some potential with the supervision of licensed medical professionals. So it is important to consider that. Like the rest of the U.S. economy, AI’s potential is being harnessed in part by organizations, both nonprofit and for-profit, in the healthcare space across the country, including telehealth.
The possibilities for future use are endless. For example, through telehealth or virtual care technologies such as remote control devices, connected health devices, other digital biomarkers, we have reams of data being collected that we can use AI to accurately understand and create. Individual care plans for Americans across the country. So that way you live a longer, healthier, better life. Finally, we can harness the vast amount of data our healthcare system produces and deploy what is learned from that data for the benefit of the patient. So that’s a huge potential.
Importantly, at the end of the day, when we think about AI deployment, you know it’s like any other tool in the vendor’s toolbox. It is not an end in itself. This technology must be used in a manner consistent with medical ethics under human supervision that deploys other technologies and other devices. There is no way to short-circuit the Hippocratic Oath, no way to short-circuit medical ethics when deploying AI. It is important.
When we think about what’s happening now, the federal government and certainly the state governments are beginning to grapple with the full implications of the AIA and what we should do, in our judgment and my judgment here at ATA and ATA Action. We have to make sure that there are clear privacy protections, we have to make sure that we don’t exacerbate questions of injustice in our health care system or exacerbate existing inequities. But at the same time, as policymakers at the federal, state, and global level in this regard, we must ensure that we are not underestimating the full potential of telehealth and healthcare, the full potential of AI to transform our healthcare system and help people live the long, healthy lives we all want. we can do it.
Medical Economics: Our primary audience is primary care physicians. What do you want to tell them or what do you want them to know?
Kyle Zeble: One, I would say that if you want your patients and your practice to continue to benefit from telehealth services, you need to make your voice heard there. You have to make sure you’re feeling it. Obviously, your organization like ATA, ATA Action, can join – and I recommend you join, to make a shameless plug – to ensure that the fight for telehealth access is in the gas. But as mentioned earlier, politics is not a spectator sport, it requires participation. If you want to make a difference, you have to call your state legislature or your state regulators, you have to call your congressman or the White House and make it clear that you don’t want any backsliding. Then it goes over the telehealth cliff, they want to make sure we reinforce and build on the positive benefits of telehealth access that happened during the pandemic.
Two, I’d say you need to know exactly how you’re deploying telehealth. It is not appropriate in all cases and varies by profession. Primary health care doctors have as much to gain as anyone from effectively deploying telehealth technology to be more efficient and more responsive in the care they provide to their patients. To make their patients’ needs as realistic as possible, what they don’t want to do in the body. Depending on the patient’s relationship with the health care system, there will always be some level of hands-on involvement with patients along the way, but most of this can be done virtually. And my advice to our physicians across the country, especially our primary care professionals, is to not be left behind. Ensure you keep your organization and practice and medicine up to date by deploying telehealth technology.
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