Since its emergence, COVID-19 has triggered a series of ongoing challenges for the healthcare system across the United States, exposing a number of core deficiencies. While the COVID-19 impact is undeniably devastating, crisis times can also be times for opportunities to highlight existing problems and unlock innovation. Mandatory social distancing, rising demand for care, and the increased cases and hospitalization have all contributed to pushing telehealth to the limelight as the safest, most convenient and interactive system between patients and clinicians in today’s novel complex setting.
Telehealth & Telemedicine: Technology Meets Healthcare
To begin with, it’s important that we define what telehealth and telemedicine mean in the context of this article.
While telehealth can simply refer to the remote provision of clinical care, it is also a broad term that encompasses all components of remote healthcare services. Telemedicine, a subset of telehealth, is defined as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration” according to the Office of National Coordination For Health Information Technology. Types of telemedicine services include video conferencing, mobile apps, remote patient monitoring devices, and electronic health information exchanges between a patient and a provider via email or instant messaging.
What Are the Implications of Telehealth Adoption and Use for Health Systems and Independent Practices?
As part of the efforts to continue mitigating the risk of spreading COVID-19, save on the use of personal protective equipment (PPE), and care for patients in a safe and effective way, came the urgent need to encourage both patients and providers to utilize telehealth services. Below is a list of the most significant temporary regulatory changes and new reimbursement models associated with telehealth use during COVID-19.
Regulatory Changes for More Flexibility
The Centers for Medicare and Medicaid Services (CMS) and the federal government have modified many regulations on the use of telehealth. In this context, The CARES Act comes with a set of loosened restrictions to expand the use of telehealth. These include:
- The availability of telemedicine is no longer restricted to patients residing in remote areas. Patients across the country can receive home telehealth services in any setting.
- Previously, providers were required to be licensed in the state where their patient is located. This requirement is now temporarily waived, meaning that as long as a provider is licensed in their home state, they can provide telehealth services from home across state lines. State restrictions may apply.
- Clinicians can provide remote patient monitoring (RPM) services to both new and established patients.
- CMS has temporarily expanded the list of services allowed during the pandemic while also making the delivery of some services via audio-only an option. A full list of allowed telehealth and audio-only services is available on the CMS website.
- The CMS emergency regulatory waivers have taken a non-enforcement position in temporarily loosening HIPAA privacy standards which opens up the opportunity for a variety of non-telemedicine apps and technologies that support real-time audio-visual features. The Office of Civil Rights (OCR) in particular has stated that there will be no consequent enforcement discretion against providers opting for the use of apps such as Zoom, Skype, or FaceTime which previously did not comply with HIPAA regulations and security rules. This excludes any public facing communication services such as Facebook Live, TikTok, Twitch etc.
- The Drug Enforcement Administration (DEA) is now permitting clinicians to prescribe controlled substances based on telehealth visits during the pandemic. The Substance Abuse and Mental Health Services Administration similarly issued a set of guidelines around the provision of methadone and buprenorphine for the treatment of Opioid Use Disorder during the COVID-19 emergency.
Prior to the COVID-19, reimbursement for telehealth and e-health services were only made available to patients in remote areas or in a limited set of circumstances and even then, the compensation rate was nothing near in-person visits. Following the national public health emergency, CMS has issued a waiver to temporarily expand coverage and reimbursement for telehealth services on a fee-for-service basis, meaning that providers will be reimbursed for both virtual and in-office visits at the same rates. Additionally, CMS has also announced increased payments for telephone visits rates from $14–41 to $46–110 per visit to match payment for office visits.
Is Telehealth Just a Pandemic Stopgap then?
Pre-pandemic, telehealth was primarily used to reach and provide care to patients in remote areas and rural regions to facilitate access to healthcare. The recent surge in telehealth, driven by the immediate need to avoid exposure to COVID-19, has expanded telehealth use throughout the U.S. While this may point to the idea that telehealth might just be a pandemic fad, statistics suggest otherwise. Telehealth is here to stay!
Mapping the trajectory of Telehealth since COVID-19:
The last week of March 2020 witnessed a significant increase in the number of telehealth visits compared to the same period in 2019. Since then, telehealth has been rapidly gaining popularity and acceptance from patients and practitioners alike.
Recent data shows that 57% of providers now view telemedicine more positively, and 64% revealed that they are more comfortable using telemedicine compared to pre-pandemic. These favorable attitudes have caused a significant number of healthcare providers of different sizes to have upscaled their telehealth offerings or adopted new remote technologies to their services list to meet patient needs.
On their part, patients have similarly expressed high levels of satisfaction with telehealth services across a wide range of health care needs. A survey on patient perspective on virtual care revealed that 77% of patients surveyed were completely satisfied with the service they received through telemedicine and e-health services. In the same survey, 75% of respondents said that they expect telehealth as an option moving forward. Interestingly enough, 35% of patients would consider switching to a different provider for telehealth visits according to The Harris Poll.
These numbers highly suggest a growing patient demand for use of telehealth, underscoring the need for healthcare institutions and practices to upscale their telehealth offerings to meet patients’ needs and expectations.
Will the Telehealth Momentum Keep Going Beyond the COVID-19 Crisis?
Driven by growing demand for easy-to-access and round-the-clock services, the vision of healthcare in a post-COVID world is already beginning to take shape. The increased adoption of telehealth services during the pandemic has given patients and providers a peek into the horizon of possibilities that technology can offer them. More than ever, patients now recognize the role of telehealth in improving and managing their personal health and it now has become an expectation that healthcare practices need to live up to. Given the favorable attitudes of both patients and providers, it is anticipated that telehealth will continue to be an instrumental component of healthcare and the next years will see hybrid models of care where telehealth works to complement in-person care depending on growth in funding, adoption, policymaking, and payment regulations.