By Katie Platz and Hannah Adams
Ten months ago, many people might not have known what telehealth was let alone visited with their health care provider through their phone or computer screen. Since the beginning of the COVID-19 pandemic, many Virginians have now seen their doctor online. It is now hard to imagine health care in Virginia without this technology.
2020: A victory for health access in Virginia
But at the start of 2020, this outcome wasn’t clear. Before March, providers in Virginia were subject to restrictive state and federal regulations. In order to visit their doctor via video chat, patients in Virginia had to go to a special location, often a health department or other clinic. While it seems counterintuitive to drive to another location to have a virtual appointment with your provider, telehealth was first created primarily to help rural patients access specialty providers, who can be located hours away.
As the U.S. response to the pandemic began in earnest, the Centers for Medicare & Medicaid Services eased restrictions including the crucial exception of allowing patients to access telehealth services in their own home. Shortly thereafter, Gov. Ralph Northam announced that he signed Executive Order 57, further easing these restrictions so that both patients and providers would be less at risk for contracting COVID-19. This E.O. allowed patients to access their health care provider from home, whereas before, they would have to travel to specified physical locations. In April alone, health insurers saw a near 9,000 percent increase in telehealth-related claims.
During the special session of the General Assembly convened in August, legislators voted to codify this change, allowing Virginians access to telehealth services at home after the public health emergency passes.
The impact of these changes has been transformative for health care in Virginia. In her testimony to Congress in June, Dr. Karen Rheuban, director for the University of Virginia’s Center for Telehealth, said that not only has this technology saved more than 21 million miles of travel for Virginians, it has also reduced hospital readmissions by more than 40 percent regardless of payer. Telehealth has also been used as “virtual PPE” (personal protective equipment) in hospitals in order to limit provider exposure, improve communication with patients in isolation and preserve physical PPE.
Disparities in telehealth access still remain
Though great strides have been made by Gov. Northam and the General Assembly, advocates for health care equity and access need to keep a discerning eye on the future. Telehealth is changing health care, rapidly. Particularly for rural Virginians, quality broadband needed to video chat with their doctor is not completely accessible. The exact number of Virginians who lack access to broadband internet remains unknown, but there is a sharp drop off of internet speeds between rural and urban areas, which is needed for these types of video calls. It is clear that this lack of rural broadband will cause unequal access to health care via telehealth.
Recommendations for Further Expansion of Telehealth in Virginia
For Virginia to continue to capitalize on the benefits, the General Assembly needs to take the following steps for the health of all Virginians:
1: Continue to fund locality-based broadband expansion: Increasing access to high-speed internet is synonymous with increasing health equity. Currently, localities are able to apply for CARES Act funding to fast-track their deployment of broadband. Individuals in communities with low broadband access can petition their local government to apply for and prioritize rural broadband in their community. Once CARES Act funding has been eliminated, there will continue to be funding streams at the state level, such as monies that come through the Virginia Tobacco Region Revitalization Commission.
2: Petition for a telehealth study on outcomes: Telehealth has never before been utilized to the extent that it has been in the months of the pandemic. It is crucial to understand the impact this has had on patient care, patient outcomes, health care utilization, health care provider perspectives and cost. Once understood, legislators can make better-informed decisions about the future of health care in Virginia and the role that telehealth plays. This allows the commonwealth to remain fiscally responsible while putting funding toward health solutions that will elevate the overall health of the state. Additionally, there are patients and providers who are resistant to transition to telehealth, and indeed there is a big difference between seeing a physician in person and through a screen. Advocates for the practice of responsible and sustainable telehealth care can petition for funding studies looking at telehealth in the context of these revised rules and regulations.
3: Continue to revise regulations: Though Virginia has made recent legislative improvements, telehealth legislation is still quite restrictive. Individuals and interest groups could ask for increased funding for services, additional services to be offered, and equal payment protections guaranteed for all providers, regardless of the payer. Additionally, the Commonwealth has not passed legislation that would allow for reimbursement of audio-only telehealth. While there needs to be more research done on this, individuals in rural areas or those without broadband access could utilize these services, if provided.
Health care will only continue to change rapidly. Without the actions by the General Assembly and Governor Northam in the past months, telehealth would not be where it is. However, not all Virginians are able to access health care equally even with the relaxed regulations, so there is still work to be done. As Bob Dylan once sang, “Times, they are a-changin’” and so too must we.
Hannah Adams is a dual degree masters candidate in public policy and public health at the University of Virginia. Katie Platz is a Ph.D. nursing student at the University of Virginia School of Nursing.