Thread by @AndreyOstrovsky

1/ Report on #telehealth from GAO has reasonable methods but draws the wrong, negatively skewed conclusion toward telehealth reimbursement that compromises health equity. Below is an elaboration why...gao.gov/assets/gao-21-…

2/ First, the researchers methods are reasonable. They primarily rely on CMS reports, which have limited utility given lack of granularity of those data, especially around disparities. But the researchers did supplement with interviews with providers, consumers, state leaders.

3/ Report appropriately finds that Medicare telehealth waivers resulted in increased utilization of telehealth services & provided beneficiaries access to services that would not have otherwise been available during the early days of the #COVID19. That was the point of waivers.

4/ Report also found that #telehealth waivers played a critical role in maintaining access to services when beneficiaries and providers were concerned about the transmission of #COVID19.

5/ These findings reinforced by interviews with groups representing providers and beneficiaries confirming flexibilities enabled beneficiaries to continue accessing care.

6/ Then @USGAO starts to draw conclusions in a regressive, rigid way regarding digital access and f/w/a. First they invoke a study showing 26% Medicare benes lacking digital access to justify NOT covering telehealth to avoid perpetuating disparities...

7/ Latter conclusion completely misses mark; lack of digital access is for VIDEO, which is all the more reason to cover audio-only (with guardrails). Additionally, more justification for all of government approach to increase digital access NOT curtail telehealth reimbursement.

8/ Another flawed conclusion from @USGAO is their concern for f/w/a. f/w/a IS a concern but telehealth can be a mechanism to REDUCE not increase f/w/a if AI/ML is creatively applied to mine the digital exhaust of digital interventions to track and prevent f/w/a.

9/ Biggest miss of all is the failure to mention that the solution to sustainable, equitable achievement of the quadruple aim isn't limiting telehealth, it's accelerating value based payment. @USGAO you can do better.