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January 30, 2023

HPC wants lawmakers to revisit telehealth laws

Photo | Courtesy of Commonwealth of Massachusetts Massachusetts State House

Lawmakers should revive and extend a pandemic-era policy requiring some telehealth services to be reimbursed on par with in-person care, a new state report recommends alongside an in-depth analysis of the remote option's exploding popularity during the pandemic.

Research the Health Policy Commission published Wednesday found a majority of Bay Staters on commercial health insurance made use of telehealth at least once in 2020, while nearly a third of all ambulatory visits and close to two-thirds of all mental health visits took place on remote platforms.

While the digital services reflected a major new facet of the state's health care landscape that year, the HPC's analysis found no significant impact on overall health care spending, which was on a rapid upward trend before the pandemic hit.

The report's authors concluded that telehealth helped increase access to mental health care, and for other services, its "effect on utilization appeared to be largely substitutive rather than additive in 2020."

"The increased use of telehealth in Massachusetts since the beginning of the COVID-19 pandemic has been a tremendous success, improving patient access to needed care, especially for mental health services," said HPC Executive Director David Seltz. "As a next step, we must work to ensure equitable telehealth access across all communities and realize potential cost savings for the Commonwealth. Through the continued support and innovation from our health plans and providers, Massachusetts can be [a] national leader in virtual care."

HPC board members voted unanimously to send the 36-page report to the Legislature following a presentation from its lead researcher, Yue Huang.

The report found that telehealth represented just a microscopic share of the state's health care landscape before the pandemic. In 2019, Huang said, only 0.6 percent of commercial insurance members had any telehealth use; in 2020, more than 50 percent of commercial insurance members used telehealth services at least once.

Use of telehealth peaked in April 2020, early on in the public health crisis, when it represented 66 percent of ambulatory visits. From August through December 2020, it hovered between 30 percent and 34 percent of ambulatory visits.

The trend lines diverged based on type of care.

Most mental health services remained on digital platforms as 2020 drew to a close, with telehealth used in 83.1 percent of ambulatory mental health visits in April 2020 and 81.2 percent in December 2020.

For all other non-mental health care, telehealth was used in 53.4 percent of ambulatory visits in April 2020 and then only 16.1 percent in December 2020.

"Telehealth use for non-mental health services was higher for residents in Metro Boston and the Pioneer Valley-Franklin region and lowest in central Massachusetts," Huang said.

Policymakers moved quickly when COVID-19 struck to make virtual health services easier to access to help Bay Staters during stretches of recommended isolation and social distancing.

A law former Gov. Charlie Baker signed in January 2021 required behavioral health services delivered via telehealth to be reimbursed on par with in-person care in perpetuity. It implemented similar telehealth parity requirements for primary care and chronic disease management, but those requirements expired on Jan. 1, 2023.

The HPC called for lawmakers to revisit the issue and revive that parity mandate, suggesting a two-year extension as a viable option.

"We think this additional time would give providers some stability and allow them to continue improving their telehealth platforms and workflow and to develop ways to best serve their patients in this hybrid model that can, in the future, take advantage of the lower resource needs for some telehealth visits relative to in-person visits," Huang said, adding that state action would be "consistent" with a federal spending bill President Joe Biden signed that extended many telehealth flexibilities until the end of 2024.

The report also called for legislative action to reduce billing complexity for telehealth and to limit providers from charging "facility fees," which some hospital outpatient departments attach to common ambulatory services. Huang said the HPC's research found about 3 percent of telehealth visits had facility claims involved.

"We know that this occurs only to a small share of telehealth visits, but this is a recommendation we sort of make on principle," she said.

Other recommendations include promotion of alternative payment methods, continued payment parity between audio and video telehealth visits, state investment in expanding access to telehealth, and better patient education on telehealth coverage and cost-sharing.

In a joint statement, the Massachusetts Medical Society, Massachusetts Health and Hospital Association and Massachusetts Telemedicine Coalition applauded the HPC's report and its "strong policy recommendations."

The groups said telehealth has been "key to maintaining access to care during the COVID-19 pandemic and providing equitable access for marginalized patients," stressing the HPC's findings that telehealth accomplishes those benefits without increasing overall health care costs.

"Telehealth has grown by leaps and bounds in just a few years, but it will not succeed in the long-run without the supports it needs to thrive," MHA Director of Virtual Care and Clinical Affairs Adam Delmolino said in a statement. "Our elected leaders have been instrumental in supporting the evolution of virtual care here in Massachusetts. We hope that many of the report recommendations, along with legislation, will help provide a roadmap for the work that lies ahead. The coalition is especially focused on enhancing digital literacy for disenfranchised communities, making patient navigators a fully-resourced part of our healthcare system, and making permanent many of the pilot programs that have expanded telemedicine's reach."

Additional HPC reports are on the horizon in the coming months examining disparities in health care supply, access and affordability as well as the pandemic-fueled health care workforce crisis. That latter report will be the topic of discussion at a special event the HPC plans to host on March 29.

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