We must acknowledge that telehealth service is not exactly comparable to in-person visits. There is no boarding or unanticipated influx of patients with telehealth. The individual patient may be similar, but the environmental circumstances are different. There is some concern of established telehealth entities siphoning off the well-reimbursing patients, making the economics of delivering in-person care more tenuous. Similarly, expansion could lead to a single emergency physician supervising multiple non-physician clinicians in various locations in ways that could radically alter the emergency medicine workforce.

Lastly, the facility fee for a telehealth visit does not incur the same direct expenses as an in-person visit. The current construct of payments for the originating site (where the patient is) and distant site (where the emergency physician is) needs to be explored for fair payment of resources used in the in-person versus telehealth visit. The practice expense component of telehealth services must be the subject of considerable cost effectiveness research.

There is no easy answer to telehealth reimbursement, and ACEP’s RUC and CPT teams will need to continually assess risk and benefit of our strategies to benefit the whole of our specialty and our patients.

Does Telehealth Amplify Social and Economic Inequality?

by Ahra Cho, MD, MBA, and Tony Bai, MD

The COVID-19 pandemic provided a nidus for growth in telehealth. Through necessity and adaptation, primary care physicians and certain specialties embraced the contactless convenience of virtual appointments with patients in need. While there is no question technology will continue to enrich the practice of medicine, there are many issues that need to be addressed in order to make telehealth safe and effective for both patients and physicians. These shortcomings are particularly evident in the application to emergency medicine.

Possibly the most concerning aspect of telehealth as it relates to our specialty is social and economic inequality. While advocates argue that telehealth would expand access to care by allowing patients increased flexibility in interfacing with clinicians, particularly patients in rural areas without constant access to care, there is genuine concern that underserved populations will be functionally impeded from accessing this service.³ This can happen both at the system and individual patient level as telehealth relies on the existing infrastructure of participants in question.

From a health systems level, telehealth systems will depend on robust information technology (IT) systems and consistent staffing. These factors put rural hospitals caring for the underserved at a disadvantage, as they are more likely to suffer deficiencies of both. Under-resourced hospital systems already struggle with high volumes of underinsured patients and lack of access to resources, including physicians and ancillary staff. Without significant increases in funding, the decision to invest in telehealth systems will require health care expenditures to be drastically reduced in other areas, particularly in-person health services and preventative care, exacerbating the access issues in already struggling communities.