What next for telehealth as patients return in person and emergency status ends

RUTLAND, Vt. (WCAX) - Telehealth appointments took over during the pandemic, but now in-office is the norm again.

Both Gifford Medical Center and the Rutland Regional Medical Center said telehealth is being used less now than it was three years ago when it began in full force. And a big question for the future of telehealth is insurance reimbursement, and balancing which types of patient care are most suited to the format.

At Gifford Medical Center, Dr. Joshua White said they never went completely virtual at the start of the pandemic but and that creating telehealth options was a massive investment. “We had to make sure that now every provider had access to a Zoom account -- that was what we used initially, a webcam. And then, of course, all of the training and education,” said White.

A major use of telehealth is appointments with a mental health therapist. White said it’s used less in specialty and primary care, but it is still used in some cases.

Gifford now has a tele-critical care contract with Dartmouth where a physician video-calls and speaks with the patient and doctors to see what resources they have and what they need.

“Patient flow and patient placement is a major issue nationally and in Vermont, and so it’s not unusual that we have a patient that requires tertiary care level, an intensive care unit type situation, and no one has beds available,” said White.

At the Rutland Regional Medical Center, Dr. Rick Hildebrant said they didn’t make huge investments in telehealth but they did take advantage of it. He says it’s not being used as much as it was. “We learned a lot and we learned that while it’s great for some encounters, it’s it’s just not the best tool for all encounters, for all people,” Hildebrant said.

Another way it’s been successful is in providing virtual insight into insulin management for patients with diabetes.

Both Gifford and RRMC say that while technology has caught up, access is a question for the future. “The big question mark for all of us is reimbursement. We have maintained reimbursement for the time being but that is all subject to change, and if the reimbursement associated with telehealth is not sustained,” said Hildebrant.

Right now, the U.S. is still in a COVID-19 public health emergency and providers are reimbursed for telehealth appointments depending on who the payer is -- Medicare, Medicaid, private, etc. White said that most telehealth appointments are reimbursed reasonably well. What comes going forward is still uncertain.

“The question is going to be how much is it going to be reimbursed. At 80% of a regular visit -- which would be, you know, reasonable. Or is it going to be reversed at 20% of a regular visit, in which case it becomes difficult to support that kind of activity. And we’ll see where that shakes out,” said White.

The White House’s public health emergency is over on May 11. But The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the pandemic through December 31, 2024.

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