An important lesson from the pandemic: Telehealth works

The ebbs and flows of the COVID-19 pandemic continue to be with us after nearly a year and a half. Currently, Americans are making new adjustments due to the Delta variant, including reverting to previous protocols from health officials or making determinations for their own households and ways of life.

Understandably, many of us cannot wait to get back to “normal” as quickly as possible, returning to what life was like before March 2020. However, once the day comes when COVID-19 is in the rearview mirror, we should not forget lessons that have been learned during the pandemic.

As a speech-language pathologist, and as president of the American Speech-Language-Hearing Association (ASHA), the emergence and acceptance of telehealth has been a revelation these past 18 months, one that warrants having it permanently covered by a wide range of public and private insurers so that it becomes much more accessible to the public.

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For years, telehealth was a form of care delivery practiced on the margins, viewed as somewhat suspect, and largely ineligible for insurance coverage. Yet, as the pandemic has taken its course, telehealth has become more fully understood as a safe, effective way for providers and patients to deliver and receive care.

One reason this happened is the Centers for Medicare and Medicaid Services’(CMS) decision to grant coverage of certain audiology and speech-language pathology telehealth services for Medicare beneficiaries for the duration of the pandemic. But CMS wasn’t alone. Nearly all state Medicaid programs and many private insurers followed suit. These critical developments opened the door to treatment for a vulnerable segment of the population who otherwise might have experienced significant damage to their quality of life.

In the big picture, there has long been many others who would stand to benefit from permanent and wide coverage of telehealth services. I am referring to people of all ages with communication disorders who live in remote areas or lack transportation or other means to be in person-to-person settings with audiologists and speech-language pathologists. Some have obtained access to telehealth due to the pandemic; it would be most unfortunate for them if the old problem of inaccessibility returned.

Early evidence already suggests that permanent and wider insurance coverage of telehealth would have a resounding positive impact. A national YouGov poll commissioned by ASHA this spring found that two-thirds of Americans are at least somewhat open to using telehealth for hearing services, and of those more than one-third said they were extremely or very open to the prospect.

Separately, studies show high levels of patient satisfaction with telehealth care for both patients and providers. In a 2020 American Journal of Physical Medicine & Rehabilitation survey, more than 90 percent of patients who received any kind of telehealth services, including with speech-language pathologists, described the experience as either “excellent” or “very good.”

On the financial side, a recent independent cost estimate found that covering audiology services under Medicare would hardly increase fiscal year spending  less than $2.5 million annually over a five-year budget period, and less than $10 million annually over a 10-year period, a pittance in the world of health care spending.

Making coverage of telehealth services permanent and widely accepted by insurers is achievable. To meet that goal, ASHA has launched a comprehensive effort that includes engaging lawmakers on legislation like the Medicare Audiologist Access and Services Act and the Expanded Telehealth Access Act, as well as state Medicaid programs and private payers with a national coverage model of audiology and speech-language pathology services. Additionally, we are supporting local advocacy by our members aimed to ensure that special education services delivered remotely are equitable for all students. Also, we are working with them to develop a database that demonstrates the short- and long-term efficacy of telehealth services.

As conditions change and the federal government and states evaluate their public health emergency declarations, reduced availability of publicly insured telehealth must be avoided. Hopefully, instead, there is recognition and acceptance that, during the pandemic, telehealth has proven it should be permanently and more widely covered by insurers, a development that would make a significant positive difference in the lives of so many. 

A. Lynn Williams, Ph.D. CCC-SLP is ASHA’s 2021 president, associate dean in the College of Clinical and Rehabilitative Health Sciences and a professor in the Department of Audiology and Speech-Language Pathology at East Tennessee State University.