Telehealth should remain part of service to rural areas

Gov. Jim Pillen’s mandate for Nebraska state workers to return to their offices, upheld by the Court of Industrial Relations, marks a significant shift from pandemic-era remote work arrangements.

However, while returning to traditional work settings might benefit some aspects of productivity and collaboration, we mustn’t entirely abandon the advancements in healthcare that emerged during the pandemic—specifically, the expansion of telehealth services.

Telehealth became necessary during the COVID-19 pandemic, providing a critical means for patients to receive medical services safely and conveniently. Since then, its popularity and utility have only grown, proving to be especially invaluable in states like Nebraska, where vast rural areas often limit access to in-person healthcare.

However, the expiration of certain pandemic-era telehealth flexibilities by the Centers for Medicare and Medicaid Services at the end of this year could pose a significant setback. A recent report by the Bipartisan Policy Center, “Positioning Healthcare Policy to Ensure High-Quality, Cost-Effective Care,” urges Congress to consider making some of these changes permanent or, at the very least, extend them.

Maya Sandalow, a senior policy analyst at the Bipartisan Policy Center, highlighted the need for further research into telehealth. She acknowledged the promising nature of existing studies. Still, she noted that the quality of telehealth services can vary widely depending on the type of service, the provider, and the mode of communication—video or telephone.

The report strongly advocates for allowing patients to choose the location for their telehealth visits and for enabling behavioral health services to be conducted via telehealth without a prior in-person visit, provided a crisis plan is in place. Nebraska has been a leader in this regard, requiring these provisions from Medicaid and state-regulated insurance companies since 2021 and ensuring payment parity since 2023. Nonetheless, only the Centers for Medicare and Medicaid Services can set these guidelines for Medicare.

The debate over payment parity—whether telehealth should be reimbursed at the same rate as in-person visits—remains contentious. Some argue it’s essential to maintain access to services, while others worry it might incentivize providers to favor telehealth over necessary in-person care. Yet, as Sandalow pointed out, telehealth undeniably increases access to care, particularly in the realm of behavioral and mental health services, which are critically needed during our ongoing behavioral health crisis.

Jed Hansen, executive director of the Nebraska Rural Health Association, added that telehealth improves access and offers a more comfortable and private option for mental health services, especially in smaller communities where anonymity can be a concern. The ability to receive care from the privacy of one’s home or a secluded office space can make a significant difference for many patients.

However, it’s also important to ensure that telehealth regulations do not inadvertently disrupt the existing local healthcare ecosystem. Hansen expressed concerns about national telehealth providers potentially undercutting local services, emphasizing the need for regulations that protect the relationship between Nebraskans and their local healthcare providers.

As we navigate the post-pandemic landscape, we must strike a balance. Returning to in-office work may benefit many aspects of our professional lives, but the gains made in telehealth should not be discarded. Instead, we should build on these advancements to ensure that all Nebraskans have access to high-quality, cost-effective healthcare regardless of location. By extending and solidifying the telehealth flexibilities established during the pandemic, we can continue to provide essential healthcare services to those who need them most.