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1、Examination of Telehealth Parity:Presenters:Dunc Williams,PhD,MHA,MTSJillian Harvey,PhD,MPH This presentation was made possible by the Health Resources and Services Administration(HRSA)of the US Department of Health and Human Services(HHS)as part of the National Telehealth Centers of Excellence Awar

2、d(U66RH31458).The contents are those of the author(s)and do not necessarily represent the official views of nor an endorsement by the HRSA,HHS or the US Government.Telehealth Utilization by State and Parity LawProvider Perceptions of ParityModeling Budget Impacts of Parity on Hospital FinanceCoautho

3、rs Sonya Ebeling,MPA1 Ryan Kruis,MSW,PhD1 James McElligott,MD,MSCR1 Kit Simpson,DrPH1 Jiebieng Wen,PhD1Medical University of South Carolina(MUSC)2Weill Cornell MedicineLearning Objectives1.Explain the results of telehealth payment parity evaluations performed at a federal,state,and organizational le

4、vel.2.Demonstrate how other organizations may perform their own telehealth payment and utilization evaluation and utilization evaluation using the Excel-based technical assistance tool we provide.BackgroundBackground Obtaining timely healthcare services can be extremely challenging for patients who

5、reside in rural or medically underserved communities.1-2 Telehealth is a promising approach to improving healthcare access and quality,while controlling costs.1-2 Reimbursement as one of the most significant barriers to telehealth utilization.Medicare began reimbursing for telehealth services in 199

6、7.4-5 Over half of Americans are covered through private health insurance.6 Telehealth parity is a critical health policy issue as the Public Health Emergency(PHE)ends.Prior studies found that states with telehealth parity policies experienced greater use of telehealth services.What is telehealth pa

7、rity?Telehealth parity laws require private insurance companies to reimburse telemedicine services similar to in-person healthcare visits.Coverage or Service Parity:Requires insurance to cover the telehealth visit Payment Parity:Requires insurers to pay for telehealth and in-person at the same rate.

8、BackgroundTelehealth Utilization by State and Type of Parity LawTimeline of State Telehealth:Initial Private Insurance Parity7-81995Louisiana1996California1997Oklahoma1999Hawaii2000Kentucky2001Colorado2006Georgia2009OregonNew Hampshire2010Virginia2012VermontMaryland2013ArizonaMissouriNew MexicoTenne

9、ssee2015 2016Alaska20172014Coverage ParityCoverage&Payment Parity2018202120202019TexasMaineMichiganDCMississippiMontanaNew YorkIndianaRhode IslandNebraskaNew JerseyNorth Dakota IowaKansasOhioSouthDakotaWest VirginiaUtahMass.ArkansasConnecticutDelawareMinnesotaNevadaWashingtonResearch Questions How d

10、oes telehealth utilization vary across states with and without parity?Is there a difference in utilization among different levels of telehealth parity(coverage vs payment)?Are there any differences in monthly visit rate trends among different levels of telehealth parity?Do Public Health Emergency me

11、asures impact the monthly visit rate trends in states with different parity levels?Methods Data Source:Merative MarketScan Commercial Claims Data Variables:Patient-level telehealth claim State parity legislation categories:No parity Coverage parity only Coverage and payment parity Years parity legis

12、lation first enacted Analysis:Diff-in-Diff model looking at tele visits/enrollees in states with different coverage modelsTelehealth Utilization by State and Parity CoverageTele visit rates in states categorized by parity lawProvider PerceptionsResearch Questions What are South Carolina providers pe

13、rceptions of telehealth parity?How do South Carolina provider characteristics and perceptions of telehealth parity impact the barriers and facilitators to utilization?Cross-sectional mixed methods survey of SC providers using snowball sampling regarding:Barriers to telehealth Confidence in understan

14、ding telehealth policy Knowledge assessment regarding parity policy Reimbursement and payment for telehealthMethodsResponse CharacteristicsPractice SpecialtyPediatrics10231.4%Family Medicine8425.9%Other8225.2%Psychiatry4513.9%Primary Care3711.4%OBGYN3310.2%Internal Medicine309.2%Emergency Medicine11

15、3.4%General Practice113.4%General Surgery82.5%Cardiovascular Disease72.2%Urology61.9%Gastroenterology51.5%Occupational Medicine51.5%Dermatology41.2%Ophthalmology10.3%LocationSuburban13140.4%Rural9729.9%Urban9629.6%Practice TypeHospital/Health System13140.3%Academic Medical Center7623.4%Independently

16、 Owned5516.9%FQHC309.2%Other195.9%Multi-site Practice Network144.3%325 RespondentsProvider Confidence&Knowledge of Telehealth PolicyTo the best of your ability,please indicate which of the following SC legal statutes regarding telehealth coverage and payment you understand to be true:n%SC has a cove

17、rage parity law(insurers must cover services that are allowable in-person via telehealth,but not necessarily at the same rate)6520.0%SC has a payment parity law(insurers must reimburse for services via telehealth at the same rate they cover those same services for in-person)72.2%SC has both coverage

18、 and payment parity(insurers must cover and reimburse in the same way for telehealth services as they do in-person services)144.3%SC has no parity law(insurers may choose which services are covered via telehealth,and may provide different reimbursement rates for telehealth vs.in-person services)9629

19、.5%Unsure16249.9%How confident are you in your understanding of telehealth coverage policies in South Carolina?ClinicalNon-Clinicaln%n%Not at all confident6121.5%718.4%Slightly confident7225.4%923.7%Moderately confident7626.8%820.1%Confident5619.7%1026.3%Very Confident196.7%410.5%Reimbursement Deter

20、ring Telehealth UseDoes the uncertainty/unavailability of telehealth reimbursement deter your practice from utilizing any of the following telehealth modalities?(check all that apply)n%Live video visits with a patient11736.0%Real-time two-way interactions between patient and provider8024.6%Audio-onl

21、y/telephone visits with a provider15848.6%Remote Patient Monitoring10632.6%eConsult 8225.2%Store and forward7422.8%Non-face to face patient initiated communications through an online portal11234.5%Other123.7%We do not use telehealth3711.4Barriers by Clinical vs.Non-clinicalSelect the top 3 barriers

22、to providing telehealth in your practiceClinicalNon-Clinicaln%n%Technical Difficulties12945.3%821.1%Patient digital literacy challenges10938.3%2052.6%Inadequate reimbursement9734.0%1436.8%Coding or billing complexities/time8329.1%1539.5%Staying up to date with current regulations8028.1%1334.2%Workfl

23、ow Inefficiencies7426.0%615.8%Denials from insurance5419.0%923.7%None279.5%513.2%Other238.1%25.3%Out-of-pocket costs for the patient186.3%513.2%Low/Lack of facility fee payment217.4%12.6%Clinical n=284(88.2%),Non-clinical n=38(11.8%)Barriers by Geography Rural n=97(29.9%),Suburban n=131(40.4%),Urban

24、 n=96(29.6%)Select the top 3 barriers to providing telehealth in your practiceRuralSuburbanUrbanN%N%N%Technical Difficulties4344.3%5340.5%4142.7%Patient digital literacy challenges4849.5%4030.5%4142.7%Inadequate reimbursement3233.0%5340.5%2728.1%Coding or billing complexities/time3132.0%3728.2%3233.

25、3%Staying up to date with current regulations2424.7%3426.0%3536.5%Workflow Inefficiencies2222.7%3123.7%2829.2%Denials from insurance2121.7%2821.4%1515.6%None99.3%1612.2%77.3%Other66.2%107.6%88.3%Out-of-pocket costs for the patient1010.3%43.1%99.4%Low/Lack of facility fee payment33.1%107.6%99.4%Model

26、ing budget impacts of lack of telehealth and in-person parity reimbursement for a hospital Objective:To provide a Technical Assistance(TA)document and Excel template to healthcare providers evaluating telehealth reimbursement relative to in-person reimbursement.Issue:Uncertain telehealth parity reim

27、bursement may have material impacts on the financial performance of providers(e.g.,hospitals and physician practices)and payers(e.g.,commercial,federal,and state).Analytical Approach:We created a TA document and Excel template providers may use to evaluate their internal data and forecast projection

28、s related to changes in telehealth payment.oImpact:Understanding the impacts of existing telehealth reimbursement,relative to in-person reimbursement and potential changes to those reimbursement levels is important for providers and policymakers.Quantifying forecasts reduces uncertainty(risk),theref

29、ore improving opportunities to effectively change/codify telehealth reimbursement.Study Design Summary:Understanding the impacts of existing telehealth reimbursement,relative to in-person reimbursement and potential changes to those reimbursement levels is important for providers and policymakers.Qu

30、antifying forecasts reduces uncertainty(risk),therefore improving opportunities to effectively change/codify telehealth reimbursement.The Telehealth Payment Parity TA document and Excel Template are available at:https:/telehealthcoe.org/telehealth-payment-parity-technical-assistance-template/Summary

31、 This work was partially funded by:o the Health Resources and Services Administration(HRSA)of the U.S.Department of Health and Human Services(HHS)as part of the National Telehealth Center of Excellence Awards(U66 RH31458 MUSC;U66RH31459 UMMC).o data analytic support for the study was provided throug

32、h support for the CEDAR core funded by the MUSC Office of the Provost.The contents are those of the author(s)and do not necessarily represent the official views of,nor an endorsement,by HRSA,HHS or the U.S.Government.This work would not be possible without collaborations with.Thank you!Funding,Discl

33、osures,and Thank Yous!1.American Telemedicine Association(2016).2016 State Telemedicine legislation tracking.Retrieved from:http:/www.americantelemed.org/docs/default-source/policy/state-legislation-matrix_2016B329BF4CEB13AA9A5AF24FC424BFE8AEF0B0.pdf?sfvrsn=6 2.Wood,J.,Mulrennan,S.,Hill,K.,Cecins,N.

34、,Morey,S.,and Jenkins,S.Telehealth clinics increase access to care for adults with cystic fibrosis living in rural and remote Western Australia.Journal of Telemedicine and Telecare 3.Mehrotra,A.,Jena,A.,Busch,A.,Souza,J.,Uscher-Pines,L.,&Landon,B.(2016).Utilization of telemedicine among rural Medica

35、re beneficiaries.JAMA,315(18)4.American Telemedicine Association(n.d).ATA state telemedicine toolkit.Improving access to covered services for telemedicine.Retrieved from:http:/www.americantelemed.org/docs/default-source/policy/ata-state-telemedicine-toolkit-coverage-and-reimbursement.pdf?sfvrsn=4 5.

36、Neufeld,J.D.,Doarn,C.R.,Aly,R.(2016).State policies influence Medicare telemedicine utilization.Telemedicine and e-Health,6.Kaiser Family Foundation(2016).Health insurance coverage of the total population.Timeframe 2014.Retrieved from:http:/kff.org/other/state-indicator/total-population7.Center for Connected Health Policy.(2023).Private Payer Parity.Available at:https:/www.cchpca.org/topic/parity/8.ATA.(2017).States with Parity Laws for Private Insurance Coverage of Telemedicine.Available ag:http:/www.americantelemed.org/policy-page/state-policy-resource-centerReferences!