POLI 330N Week 7 Assignment: Final Project – Policy Issue

POLI 330N Week 7 Assignment: Final Project - Policy Issue

Concern or Problem – Telehealth Policy

The COVID-19 pandemic has shown infrastructure issues, discrepancies in care, poor disaster or emergency management and the problems that exist in the current health care facilities (Chao et al., 2021). As the patients suffering from different conditions failed to use and access different health care services, nurses and health care professionals failed to provide quality care, which included home-based care, support, hospice care, community-based care, and effective care in the hospital (Johnston et al., 2021). However, telehealth-based services helped the health care organizations to provide care, but the policies of telehealth services have their own issues (Shaw et al., 2020). The purpose of this policy paper is to analyze the telehealth policy issues with evidence to propose an action plan with recommendations to members of congress by analyzing their importance and relevance in lobbying for the policy changes.  

Defining problem, identifying its importance, and urgency

Telehealth services are not permanent in the USA despite health care service providers having the resources to provide services to the patients (Shrank et al., 2021). Even though COVID-19 crisis led to a surge in telehealth service use as more than 9 million users are associated with it, the services are mainly used because of COVID-19. The number of beneficiaries increased to 1.7 million users per week to 13,000 users (Shaw et al., 2020). This indicates that patients are willing to continue to use the telehealth, but there is no policy to make the telehealth service permanent. 

The importance of this problem is falling to address the issue will result in a greater number of patients failing to access the care. It is expected that at least 42% of patients fail to access health care when they are in rural areas or remote places (Wegermann et al., 2021). The rate is expected to increase as not all the facilities have telehealth services as it takes time to implement an IT infrastructure to facilitate the service. The second issue related to the problem is it increases mortality rate as one study highlighted that failing to access the care led to 42985 cases and 1062 deaths related to opioid disorder in rural areas of North Carolina from March to June 2020 (Hughes et al., 2021). The same study highlighted that telehealth visits peaked till May and after that there was a sharp decline in the visits. This increased health care complications (Hughes et al., 2021). 

As the telehealth services were not a permanent part of the system, many health care professionals and organizations failed to obtain the licenses as restrictions by Federally Qualified Health Center (FQHC) were strict (Shrank et al., 2021). Further, due to different reasons such as network issues, unavailability of high-speed internet, network security, and poor-quality services, video-based services cannot be provided (Johnston et al., 2021). In such cases, audio-only health care services should be used, but there is no clear policy related to this problem. 

This is important as sticking to video-only care prevents health care access, which results in mortality rate, high healthcare costs, and hospital readmission. For example, the study showed that FamTechCare intervention, which used both audio and video services reduced health care cost to $6.9 per dyad/week from video-based care of $48.43 (Shaw et al., 2020). By considering aspects of reduced health care access, high-cost services, and issues such as mortality and morbidity, the issue is of high importance and urgency. 

POLI 330N Week 7 Assignment: Final Project – Policy Issue

Analyzing the problem

The problem of implementing a policy to continue telehealth services permanently includes issues such as poor access to health care, cost of care, policy related to video and audio services, ease of telehealth license accreditation for health care services and healthcare professionals, and cost of care. 

In their study, Wegermann et al. (2021) highlighted that 42% Hispanic patients and 41% other patients found it hard to access health care. Further, out of 13628 visit attempts, 3771 visits were either cancelled or rescheduled. This is a major indicator that despite wanting to get appointments, patients did not get the service. As a result, it is important to implement the service so that everyone can access the health services. This further allows the health care facilities to use both video and audio services based on the need to reduce overall cost.

Gajarawala & Pelkowski (2021) reviewed effects of telehealth regulatory and legal issues and found that more than 30% health care professionals found it hard to get the license in time and organizations could not implement the telehealth services completely, which resulted in delayed care, high mortality rate, and health care complications. This indicates the need to lift some of the restrictions, which resulted in a limited number of approvals. Permanently removing FQHC restrictions and creating a better licensure requirement will be beneficial. 

Health care cost is a high contributing factor as in the US there are 8.95 uninsured population and it is expected that it will reach 10.6% or 37.2 million by 2028 (Shrank et al., 2021). The market of telemedicine is expected to cross $185 billion by 2026 and as the health care cost is increasing at 5.5% rate every year, the telehealth services aid in reducing health care cost (Fortune, 2021). For example, health care professionals who provided telemedicine services highlighted that they saved $19 to $21 for every telemedicine visit (Fortune, 2021). 

A report by United Health Group highlighted that 67% ER or emergency room visits can be avoided and it will reduce the cost by $32 billion every year (UHG, 2021). This indicates that if ER visits alone can save $32 billion a year, then savings from limited use of hospital resources. Increased use of technology, reduction in transportation cost, reduced errors by health care professionals, and reduced hospital visits would be highly beneficial.   

Target members of Congress for lobbying

For the issue of telehealth policy, I would choose Lauren Underwood, Cheri Bustos, Doris Matsui, and Mike Thompson. Lauren Underwood will be highly critical as she was a registered nurse and understands the importance of telehealth access in health care, challenges faced by different stakeholders, and ways to implement a policy to make telehealth a permanent part of health care system. She has written a detailed article on the topic of policy and telehealth and conducted interviews to change policies. As a result, it will be easy to communicate with her (Underwood, 2021; Wicklund, 2021). Further, she has advocated for policy issues in health care such as high-quality, affordable and accessible care for everyone, American Rescue Plan to reduce pocket premiums in health care, family health partnership clinics, urgently deliver care during COVID-19, prioritizing mental health care for veterans, Black Maternal Health Momnibus Act, and other issues (Underwood, 2021). She is best suited for policy lobbying. As a result, she will be the key congressperson. 

Cheri Bustos is a health care executive who represents D-IL 17th District. She has conducted podcasts on telehealth at Facebook and also voted for Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which is critical for telehealth service deliverables (Buston, 2021). As she is a healthcare executive, her opinion is of high value. This is critical. Both Rep. Doris Matsui and Rep. Brett Guthrie will be beneficial for the policy as they are vocal about modernizing telehealth policies and expanding the services. As they have concentrated on expanding telehealth by removing restrictions of Medicare, they aid in getting more attention to set an agenda and carry it (Jercich, 2021). 

Recommendations for the problem solving

  There are four key policy changes and update recommendations. Each of the recommendations target individual problems such as issues in health care access, expansion of telehealth with both audio and video-based care, removing restrictions on health care and health care professionals, and permanently allowing key health care professionals to provide telehealth care. The recommendations are as follows

  • Create a policy and implement it to make telehealth services permanent where patients can access the health care even after the COVID-19 pandemic. The policy addresses health care access issues even for citizens living in rural and remote areas. 
  • Permanently lift FQHCs restrictions, which prevent other health care facilities from providing care. However, policies should be formed so that everyone adheres to best practice protocols. 
  • Permanently provide license to clinical practitioners such as psychiatrists, nutritionists, occupational therapists, speech pathologists, and physical therapists.
  • The Secretary of Health and Human Services or (HHS) will have authority to provide relaxation based on cases and priority. 
  • Both video and audio-based telehealth services will be part of the system. 
  • Include Medicaid and subsidies to increase the use of telehealth services to reduce health care costs. 

POLI 330N Week 7 Assignment: Final Project – Policy Issue

References

Buston, C. (2021). Bustos helps pass $8.3 billion coronavirus funding package – congresswoman Cheri Bustos. Congresswoman Cheri Bustos. Retrieved 9 April 2021, from https://bustos.house.gov/bustos-helps-pass-8-3-billion-coronavirus-funding-package/.

Chao, G., Li, K., Zhu, Z., McCullough, J., Thompson, M., & Claflin, J. et al. (2021). Use of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surgery. https://doi.org/10.1001/jamasurg.2021.0979

de Jong, M., Boonen, A., van der Meulen-de Jong, A., Romberg-Camps, M., van Bodegraven, A., & Mahmmod, N. et al. (2020). Cost-effectiveness of telemedicine-directed specialized vs standard care for patients with inflammatory bowel diseases in a randomized trial. Clinical Gastroenterology And Hepatology18(8), 1744-1752. https://doi.org/10.1016/j.cgh.2020.04.038

Fortune. (2021). Telemedicine market size, share, growth & trends [2020-2027]. Fortunebusinessinsights.com. Retrieved 9 April 2021, from https://www.fortunebusinessinsights.com/industry-reports/telemedicine-market-101067.

Gajarawala, S., & Pelkowski, J. (2021). Telehealth benefits and barriers. The Journal For Nurse Practitioners17(2), 218-221. https://doi.org/10.1016/j.nurpra.2020.09.013

Hughes, P., Verrastro, G., Fusco, C., Wilson, C., & Ostrach, B. (2021). An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic. The Journal Of Rural Health. https://doi.org/10.1111/jrh.12570

Jercich, K. (2021). In telehealth hearing, House committee weighs access against cost. Healthcare IT News. Retrieved 9 April 2021, from https://www.healthcareitnews.com/news/telehealth-hearing-house-committee-weighs-access-against-cost.

Johnston, R., Kobb, R., Marty, C., & McVeigh, P. (2021). VA video telehealth and training programs during the COVID-19 response. Telehealth And Medicine Today. https://doi.org/10.30953/tmt.v6.241

Shaw, C., Williams, K., Lee, R., & Coleman, C. (2020). Cost‐effectiveness of a telehealth intervention for in‐home dementia care support: Findings from the FamTechCare clinical trial. Research In Nursing & Health44(1), 60-70. https://doi.org/10.1002/nur.22076

Shrank, W., DeParle, N., Gottlieb, S., Jain, S., Orszag, P., Powers, B., & Wilensky, G. (2021). Health costs and financing: challenges and strategies for a new administration. Health Affairs40(2), 235-242. https://doi.org/10.1377/hlthaff.2020.01560

UHG. (2021). The high cost of avoidable hospital emergency department visits – unitedhealth group. Unitedhealthgroup.com. Retrieved 9 April 2021, from https://www.unitedhealthgroup.com/newsroom/posts/2019-07-22-high-cost-emergency-department-visits.html.

Underwood, L. (2021). Why nurses should be guiding, making health policy: rep. underwood offers view from the hill. Columbia School of Nursing. Retrieved 9 April 2021, from https://www.nursing.columbia.edu/news/why-nurses-should-be-guiding-making-health-policy-rep-underwood-offers-view-hill.

Underwood, L. (2021). Representative Lauren Underwood. Retrieved 10 April 2021, from https://underwood.house.gov/.

Wegermann, K., Wilder, J., Parish, A., Niedzwiecki, D., Gellad, Z., Muir, A., & Patel, Y. (2021). racial and socioeconomic disparities in utilization of telehealth in patients with liver disease during COVID-19. Digestive Diseases And Sciences. https://doi.org/10.1007/s10620-021-06842-5

Wicklund. (2021). Telehealth plays a key role in black maternal Momnibus cat of 2021. mHealthIntelligence. Retrieved 9 April 2021, from https://mhealthintelligence.com/news/telehealth-plays-a-key-role-in-black-maternal-momnibus-act-of-2021.

POLI 330N Week 7 Assignment: Final Project – Policy Issue