Telehealth's digital divide is real, and members of Congress want to address it
U.S. Reps. Robin Kelly, D-Ill., and Anna Eshoo, D-Calif., convened yesterday with Dr. Gary Puckrein, president and CEO of the National Minority Quality Forum, to stress the importance of considering the barriers to healthcare people still face throughout the country.
Even as the COVID-19 pandemic has magnified telemedicine's potential to expand access to care, said the Congress members, it has also highlighted existing disparities in our system. Broadband access is an issue, as many telehealth advocates have pointed out, but so are digital literacy and the insurance coverage of remote monitoring devices.
"Some Americans don't have or can't afford a phone," said Kelly. "Will we allow them to be left behind in this revolution?"
Eshoo, who chairs the House Energy and Commerce Subcommittee on Health, noted that she's certainly recognized the importance of telehealth over the years, but that the novel coronavirus crisis has moved it "to the front burner."
Still, she said, "we know we have inequities in systems across the board," and the healthcare system is no different. Kelly, chair of the Congressional Black Caucus Health Braintrust and cochair of the House Tech Accountability Caucus, pointed to her bill, the "Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020," as a vital step forward in addressing those disparities.
As Kelly told Healthcare IT News, when the bill was introduced in June, the legislation required the Secretary of Health and Human Services to conduct a study within a year of the end of the emergency period that would summarize healthcare utilization patterns during the coronavirus. Kelly said in an interview earlier this year she hopes the bill, which will call for an analysis of telehealth use broken down by race and ethnicity, geographic region and income level, will draw attention to disparities exacerbated by the digital divide.
The legislation, currently in committee, would also require the Secretary to describe expenditures and savings as a result of telehealth, any privacy concerns, and any instances of fraud.
Spending has been a hot-button issue among telehealth stakeholders, some of whom have proposed different fee schedules for physicians who participate in alternative payment models.
As Puckrein pointed out, telehealth goes beyond synchronous, one-on-one video or phone calls. It also encompasses remote patient monitoring devices, which can give clinicians a fuller picture of patient health. Virtual care "is going to revolutionize medicine," he said, "but there really are important concerns."
"We've got to make sure those devices are available and that physicians can have access to that information," said Puckrein.
In response to a question from Healthcare IT News, Puckrein elaborated that the divide is already beginning to make itself known. "The data is showing that not all patients living with diabetes have access" to devices that monitor blood glucose, for example.
"It's showing up in healthcare outcomes. We have to pay a lot of attention to this," Puckrein continued. If not, Puckrein said, "we're really going to open the door up to a whole range of health disparities that will be difficult to unravel."
"Obviously we need the expansion of broadband," Eshoo added. But on the Medicare side, she said, "We have to ensure that when we make [telehealth] permanent that … cutting-edge technologies are part of the reimbursement. Otherwise telehealth won't work."