Extend Telehealth Benefits Or Not Post Pandemic? Yet Another Reason For Standardized Quality Measures In Mental Health And Addiction Treatment.

In Illinois there is a hotly contested bill in front of the Illinois legislature called, “HB3498”. Once heard this debate will focus on whether or not, and if so how to extend telehealth coverage beyond the pandemic for addiction and mental health treatment. Prior to the pandemic telehealth was a rarely used platform in our field. The requirements to provide it were steep and the reimbursements were a fraction of in person treatment. Once the pandemic hit, however, exceptions were made which enabled providers like us to be able to continue to treat patients from their homes, at the same rates and with many of the restrictions temporarily waived. This happened almost overnight. It was a blessing at the time.

People struggling with mental health and addiction often feel alone and disconnected from others and even themselves. It is through meaningful and healthy connection with others that they are able to regain hope and begin the recovery journey. The required physical distancing was the worst case scenario for many of our patients. It was a gift to their disease and a major impediment to their desire to heal. The extension of telehealth coverage at this time was an olive branch. Undoubtedly it saved countless lives and we will forever be grateful to the state of Illinois, our Governor, insurance companies (even if they joined in kicking and screaming!), our staff and our patients for enabling and supporting the switch.

Now that we may be nearing the Covid finish line, many (providers) are asking for these exceptions to be made permanent. HB3498 seeks to extend telehealth coverage beyond the pandemic, requiring that therapeutic sessions be covered at the same rate as in person sessions and without having to go back to having to use “approved” telehealth providers such as MDLive. The bill seeks, “Telehealth Parity”. The bill is understandably overwhelmingly supported by individual “private practice” providers throughout Illinois and naturally opposed by several major insurance companies including BCBS Illinois.

While we certainly believe there should always be a place for telehealth, particularly for those in underserved communities, we are surprised (but not really!) by the lack of any meaningful discussion on QUALITY in this debate. If one side could show with reliable, meaningful and standardized data that quality is positively, negatively or negligibly affected when comparing in person versus telehealth services, certainly that would go a long way in bolstering its argument. Unfortunately, no such data exists. In fact, in our space we can’t even agree on data to compare our IOP to the IOP across the street, which results in the exact same adversarial based debate between payer and provider with patients getting squeezed and hurt in the process. We end up arguing over whether or not our reimbursement rate should be $350 or $360/day without ANY regard for the quality or value that we are providing (or not) and with the explanation from the payer being, “this is what we are paying the guys across the street so this is the most we will pay you….”. Terrible.

Again, there is no doubt that there should always be a place for telehealth. Without a doubt we witnessed first-hand the power it had during the pandemic with the lives that might have been lost were we not able to provide services at this time when we didn’t even know if the air we were breathing was safe from Covid. However, from our standpoint, it wasn’t as useful as in person programming for many of our patients. Staring at a computer screen for 6+ hours 5 days per week, oftentimes in pajamas in a dark room by themselves is just not as effective as bringing humans together in a room to work through their issues and challenges. Our patients benefit from group-based programming and groups are generally more effective for many of our patients in person. Further, taking (blind) weights and vitals proved to be quite the challenge when people were forced to stay at home and resulted in a diminished ability on our part to optimize their care.

We also know that providing telehealth can be less expensive than in person programming. It wasn’t for us during the pandemic because we still had a large empty office space where our patents once gathered. However, if we did not need these large offices, our costs would be significantly lower when taking into consideration the additional costs needed to safely and effectively provide HIPAA compliant telehealth programming.

I can also speak from personal experience. Prior to Covid my psychiatrist would often have to nudge me out of his office after our weekly 45-minute session. Just last week I barely lasted 20 minutes and I essentially told him that I was “done” with Facetime sessions. Over the past few months I would find myself checking emails and texts while talking with him. This never happened when we met in person. Fortunately, we are both vaccinated and decided next week to meet in his backyard. I just can’t connect the same way, yet I am incredibly grateful for the time we did have as I would never have wanted to go all this time without the support!

The bottom line is that all sides in this debate over whether or not to extend telehealth “parity” have valid and sound points. However, having the discussion without quality measures is really not smart for any of us and as always it will be our patients who suffer with any decision that is made without regard for quality or value.