No doubt about it, COVID-19 is changing the way we work, live and play. It has pushed us to adopt approaches that we may have been resistant to before – from working from home to online education to telehealth.
Telehealth, in particular, has been waiting for its moment. In the U.S., the first recorded instance of telemedicine happened more than 60 years ago (!) when the Nebraska Psychiatry Institute began using closed-circuit TV for psychiatric consultations. Telehealth, as we know it today, required many technological innovations – personal computers, the internet, smartphones – but wide-scale adoption was being held back by factors that had nothing to do with technology. Good old red tape – and old habits.
Like elsewhere in our lives, the pandemic has given telehealth the nudge that it needed:
Changing regulatory and licensing requirements
Historically, with limited exceptions, telehealth consultations with a physician in the U.S. had some geographic challenges. Physicians were required to be licensed in the state where the patient was located at the time of treatment. As a result of new COVID-19 policies, however, the Centers for Medicare & Medicaid Services (CMS) is waiving this requirement for Medicare patients, and states are able to require a waiver for Medicaid patients.
CMS has also expanded the list of services that can be provided via telehealth and the delivery method, including virtual check-ins, e-visits, and telephone services for patients – whether they are new or established.
Allowing critical research to stay on track
As we are seeing elsewhere around the world, clinical trials are being disrupted – due to shelter-in-place, social distancing, pausing of elective procedures and appointments – and in some circumstances, investigators and trial sites are adapting by incorporating telehealth into their methodologies and reporting structures. While many clinical trials have been postponed or cancelled in light of safety and public health concerns, the verdict is still out whether there is longevity for expanding further use of telehealth in clinical trials when we re-emerge into the next normal.
Reducing the burden on healthcare providers
“Flatten the curve” has been the rallying cry – and most Americans seem to understand the concept. Let’s not flood our healthcare system with COVID cases or illnesses that can be managed through telemedicine. Telehealth is helping support efficient healthcare utilization by assessing symptoms and helping triage patients based upon their needs. Will this change what constitutes a trip to the physician’s office or emergency department versus a telehealth consult? Time will tell.
In a December 2017 survey, 82% of U.S. respondents said they did not use telehealth. Now in March/April 2020 – according to a new survey, two-thirds say COVID-19 has increased their willingness to try telehealth in the future. One-quarter of respondents had not considered this as an option before.
Effective March 1 and throughout the COVID-19 pandemic, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just services related to COVID-19. Prior to the pandemic, many physicians were reimbursed at only a fraction of their in-office visit rate (if at all) for telehealth services.
Evolving care for rural communities
Rural healthcare was challenged before COVID-19 with more than 350 rural hospitals at high risk of closure. These community hospitals have razor-thin margins that rely on procedures like elective surgeries and imaging that have been slashed during COVID-19. The reality is that healthcare delivery in rural communities needs to move to greater use of telemedicine for routine care and COVID-19 has helped shine a light on some of the continued barriers – including lack of broadband access. New CMS provisions are helping bridge the technology gap by allowing physicians to provide audio-only telephone evaluation and management visits for new and established patients, which is especially helpful for rural communities and seniors.
Telehealth has been underutilized for many years due to outdated regulations that limited its growth. If there is anything positive to come out of the COVID-19 pandemic, it just might be that telehealth emerges as a long-term solution to many of the challenges we are facing with health care utilization and rural health care. Is this just the start of a new dawn for telehealth? Or will CMS and consumers revert to pre-COVID regulations and behaviors?
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