POLI 330N Week 7 Assignment: Final Project – Policy Issue

Name

Chamberlain University

POLI-330: Political Science

Prof. Name

Date

Concern or Problem – Telehealth Policy

The COVID-19 pandemic revealed critical infrastructure issues, care discrepancies, inadequate disaster or emergency management, and inherent problems within current healthcare systems (Chao et al., 2021). As patients suffering from various conditions were unable to access healthcare services, healthcare providers, including nurses, struggled to deliver quality care. This included home-based care, hospice care, community-based care, and effective hospital care (Johnston et al., 2021). Although telehealth services offered some relief, the policies governing these services come with their own set of challenges (Shaw et al., 2020). This policy paper aims to analyze telehealth policy issues and propose an action plan with recommendations to Congress members, stressing the importance and relevance of these policies in lobbying for necessary changes.

Defining the Problem, Identifying Its Importance, and Urgency

Despite the capacity to deliver telehealth services, the United States has not yet made these services permanent (Shrank et al., 2021). Although the COVID-19 pandemic caused a surge in telehealth usage, rising to over 9 million users, these services are largely viewed as temporary measures prompted by the crisis. For example, the number of telehealth beneficiaries rose from 1.7 million users per week to 13,000 users after the pandemic (Shaw et al., 2020). Patients have shown a willingness to continue using telehealth services, but there is no current policy to make this option permanent.

The importance of this issue is clear. Failing to address it would result in a larger number of patients being unable to access healthcare, especially in rural or remote areas, where 42% of patients are already struggling to receive proper care (Wegermann et al., 2021). This percentage is likely to increase due to the delayed implementation of necessary IT infrastructure to support telehealth services. Furthermore, restricted healthcare access leads to higher mortality rates. One study noted that the inability to access care resulted in 42,985 cases and 1,062 deaths related to opioid disorder in rural areas of North Carolina between March and June 2020 (Hughes et al., 2021). This study also highlighted a peak in telehealth visits in May, followed by a sharp decline, which in turn caused increased healthcare complications (Hughes et al., 2021).

POLI 330N Week 7 Assignment: Final Project – Policy Issue

In addition, the non-permanent nature of telehealth services meant that healthcare providers and organizations faced difficulties obtaining licenses, mainly due to strict restrictions imposed by Federally Qualified Health Centers (FQHCs) (Shrank et al., 2021). Other issues, such as network problems, unavailability of high-speed internet, and video quality, further hindered telehealth service delivery (Johnston et al., 2021). In such cases, audio-only services should have been used, but current policies lack clarity on this front.

This is crucial because restricting telehealth to video-only services exacerbates healthcare inaccessibility, leading to increased mortality, higher healthcare costs, and hospital readmissions. A study on the FamTechCare intervention, which utilized both audio and video services, found that it reduced healthcare costs to $6.9 per dyad/week compared to video-based care, which cost $48.43 (Shaw et al., 2020). Given the impacts on healthcare access, service costs, and health outcomes, addressing this issue is both important and urgent.

Analyzing the Problem

The central issue in making telehealth services a permanent solution involves challenges such as limited healthcare access, high costs, inadequate policies for video and audio services, telehealth license accreditation difficulties, and overall healthcare expenses.

Wegermann et al. (2021) found that 42% of Hispanic patients and 41% of other patients faced significant barriers to accessing healthcare. Furthermore, of 13,628 appointment attempts, 3,771 were either canceled or rescheduled, indicating a demand for healthcare services that was not met. This emphasizes the importance of permanently implementing telehealth services to ensure equitable access to healthcare. Additionally, telehealth should include both video and audio services, depending on patient needs, to lower overall costs.

Gajarawala and Pelkowski (2021) discussed the regulatory and legal challenges of telehealth, noting that over 30% of healthcare providers struggled to obtain timely licenses. Many organizations were unable to fully implement telehealth services, resulting in delayed care, increased mortality, and worsening health outcomes. To address this, lifting some restrictions on FQHCs and easing licensure requirements would be beneficial.

POLI 330N Week 7 Assignment: Final Project – Policy Issue

Healthcare costs in the U.S. are another major concern. The country currently has 8.95 million uninsured individuals, a number expected to rise to 37.2 million by 2028 (Shrank et al., 2021). The telemedicine market is projected to surpass $185 billion by 2026, and with healthcare costs rising by 5.5% annually, telehealth services offer a viable way to reduce these expenses (Fortune, 2021). For instance, healthcare professionals reported saving $19 to $21 per telemedicine visit (Fortune, 2021).

A report from United Health Group indicated that 67% of emergency room (ER) visits could be avoided, which could save the healthcare system $32 billion annually (UHG, 2021). These potential savings, along with reduced use of hospital resources, lower transportation costs, fewer errors by healthcare professionals, and fewer hospital visits, underscore the importance of telehealth in reducing healthcare costs.

Target Members of Congress for Lobbying

To effectively lobby for a telehealth policy, I would recommend approaching Congress members Lauren Underwood, Cheri Bustos, Doris Matsui, and Mike Thompson. Lauren Underwood, a registered nurse, understands the importance of telehealth in improving healthcare access and addressing stakeholder challenges. Her active involvement in health policy advocacy, including affordable and accessible care, makes her an ideal candidate for supporting this initiative (Underwood, 2021; Wicklund, 2021).

Cheri Bustos, a healthcare executive representing D-IL 17th District, has expressed strong support for telehealth services through her podcasts and voting record, including her support for the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Bustos, 2021). Rep. Doris Matsui and Rep. Brett Guthrie have also been vocal proponents of modernizing telehealth policies and expanding services by advocating for the removal of Medicare restrictions, making them valuable allies in this effort (Jercich, 2021).

Recommendations for Solving the Problem

To address the issues surrounding telehealth services, I propose the following four policy changes:

Establish a permanent telehealth policy to ensure continued access to healthcare services post-pandemic, with a particular focus on rural and remote areas.
Permanently lift FQHC restrictions to enable more healthcare facilities to offer telehealth services, while ensuring adherence to best practice protocols.
Grant permanent telehealth licenses to clinical practitioners, including psychiatrists, nutritionists, occupational therapists, speech pathologists, and physical therapists.
Allow the Secretary of Health and Human Services (HHS) to grant case-based and priority-based policy relaxations. This policy should include both video and audio telehealth services, as well as Medicaid and subsidies to increase access and reduce healthcare costs.

References

Buston, C. (2021). Bustos helps pass $8.3 billion coronavirus funding package – congresswoman Cheri Bustos. Congresswoman Cheri Bustos. https://bustos.house.gov/bustos-helps-pass-8-3-billion-coronavirus-funding-package/.

Chao, G., Li, K., Zhu, Z., McCullough, J., Thompson, M., & Claflin, J. et al. (2021). Use of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surgery. https://doi.org/10.1001/jamasurg.2021.0979

Fortune. (2021). Telemedicine market size, share, growth & trends [2020-2027]. Fortunebusinessinsights.com. https://www.fortunebusinessinsights.com/industry-reports/telemedicine-market-101067.

Gajarawala, S., & Pelkowski, J. (2021). Telehealth benefits and barriers. The Journal For Nurse Practitioners, 17(2), 218-221. https://doi.org/10.1016/j.nurpra.2020.09.013

Hughes, P., Verrastro, G., Fusco, C., Wilson, C., & Ostrach, B. (2021). An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic. The Journal Of Rural Health. https://doi.org/10.1111/jrh.12570

POLI 330N Week 7 Assignment: Final Project – Policy Issue

Jercich, K. (2021). In telehealth hearing, House committee weighs access against cost. Healthcare IT News. https://www.healthcareitnews.com/news/telehealth-hearing-house-committee-weighs-access-against-cost.

Johnston, R., Kobb, R., Marty, C., & McVeigh, P. (2021). VA video telehealth and training programs during the COVID-19 response. Telehealth And Medicine Today. https://doi.org/10.30953/tmt.v6.241

Shrank, W., DeParle, N., Gottlieb, S., Jain, S., Orszag, P., Powers, B., & Wilensky, G. (2021). Health costs and financing: challenges and strategies for a new administration. Health Affairs, 40(2), 235-242. https://doi.org/10.1377/hlthaff.2020.01560