A new study commissioned by the U.S. Department of Health & Human Services identified barriers Federally Qualified Health Centers (FQHCs) face in creating telehealth programs and the impact of Medicaid policy on implementation. The majority of the 19 FQHCs interviewed reported losing money on telehealth services.
In 2016, the Health Resources and Services Administration reported that 40 percent of community health centers nationally offered some type of telehealth. The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) commissioned RAND researchers to study telehealth and Medicaid policies in seven states: Oregon, Pennsylvania, Iowa, Connecticut, Mississippi, Virginia and New Mexico.
The study found that Medicaid policies vary widely by state, and participants described a lack of clarity on which services were allowed by the Medicaid program. Four of the seven state Medicaid programs reimbursed for store-and-forward telehealth, and two reimbursed for remote patient management (RPM). It noted that four programs had patient informed consent requirements, and three required telepresenters to be present with patients at originating sites. Two programs restricted the types of specialists or services that can be provided by telehealth, and five provided a transmission and/or facility fee to eligible originating sites.
The report noted that FQHC stakeholders identified multiple barriers beyond reimbursement, “including infrastructure issues (insufficient broadband), technology costs, telehealth as a cost center, billing challenges, lack of buy-in among FQHC providers, challenges specific to the patient population (elderly patients, homeless patients), complexities in adjusting clinic workflow, inadequate supply of specialists to provide telehealth services to FQHC patients, complex and time-consuming logistics around credentialing and licensing, and challenges in working with remote providers.”
The majority of FQHCs interviewed across all telehealth models reported losing money on telehealth services, but they offered the service because it aligned with their mission to serve vulnerable patients. Yet RAND found that the inability to break even with telehealth services was a barrier to the sustainability and expansion of telehealth programs. FQHC representatives reported losing money due to insufficient reimbursement, the high cost of equipment and contracted specialists’ time, and high no-show rates.
Yet FQHC representatives said they could overcome these barriers to telehealth implementation if reimbursement, and the risk of losing revenue in offering telehealth services, were improved.
Several discussed plans to expand existing offerings by serving additional sites or increasing volume or offering additional specialties. Others, however, discussed plans to discontinue their telehealth programs or described previous pilot programs that were not sustained, RAND reported.
