Telehealth in Urban Areas? Health Affairs Op-Ed Highlights Need

When it comes to the debate over telehealth reimbursement, advocates frequently tend to focus on the benefits that increased reimbursement could bring to rural, underserved communities—places where, by having access to telehealth care, patients could theoretically avoid having to drive long distances to see a specialty provider, or where small-town hospital closures have left residents with few options when they’re in urgent need of care. But, as the authors of a recent Health Affairs op-ed point out, there are just as many challenges to health care access in our nation’s urban communities—and expanded telehealth reimbursement could prove just as helpful to them as it could to their rural counterparts. As Becker’s Hospital Review and others first reported, the op-ed argues that the Centers for Medicare and Medicaid Services (CMS) should reframe the way in which it calculates reimbursement. “While geography is an important aspect of access to health care, it fails to accurately capture the relationship between supply (providers) and demand (patients) within an area,” the authors explain.

The four authors, three of whom are based at Thomas Jefferson University Hospital and one of whom is based at Princeton University, outline some of the health care access issues that patients in urban areas face—specifically, due to competition for limited physician time. “Urban America has access problems because there are not enough appointment,” they explain. They point to a study using simulated patient calls, the results of which showed that patients located in rural communities were more likely than their urban counterparts to be offered a primary care appointment (80 percent vs. 60 percent). A study of urban and rural Medicaid patients seeking specialty care showed similar results, as did several Medicare Payment Advisory Commission (MEDPAC) surveys. But CMS policies fail to reflect this; as the authors put it, “current Medicare payment policies target geography, and therefore do not focus on the real problem, which is access.”

What, then, can CMS do to help increase access to care—and what can individual health systems do? “To successfully transform health care through telemedicine, expectations and incentives must be aligned across payers, health systems, providers, and patients,” the authors assert. They note that some telehealth programs have had success in treating patients in need from both urban and rural communities, pointing to the Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) program at the University of Arkansas for Medical Sciences (UAMS) as one example of a particularly effective model. (CTeL’s own board chairman, Dr. Curtis Lowery, heads up the Department of Obstetrics and Gynecology at UAMS.) ANGELS, the authors explain, virtually connects high-risk pregnant Medicaid patients throughout the state—in both urban and rural communities—with specialists. “The best way to care for patients in rural environments is to build programs that synchronize rural and urban care,” the authors explain. They encourage “the use of appointment timeliness as a marker for access,” and urge CMS to look beyond geography when looking at access issues. In sum, “aligning payment structures to focus on the availability of timely care instead of historic geographic constructs is essential.”

Click here to read the article from Becker’s Hospital Review on telehealth in urban communities.

Click here to read the Health Affairs op-ed on telehealth in urban areas.


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