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April 1, 2020
In these unprecedented times when public arenas are being converted to makeshift hospitals and nonessential medical procedures are being cancelled, telehealth has offered a beacon of light for both healthcare providers and patients alike. It has become an indispensable tool creating much needed access points to care while freeing up medical staff and equipment to treat Coronavirus (“COVID-19”) patients. As the pandemic has engulfed the nation, health systems, providers and patients are looking to telemedicine to combat COVID-19 and mitigate its spread.
*Note that both terms of ‘telehealth’ and ‘telemedicine’ will be used interchangeably throughout this article, as some of the regulatory provisions mentioned herein may include remote clinical services (“telemedicine) as well as non-remote clinical services, such as provider training and administrative meetings (“telehealth”).
In March 2020, the Centers for Medicare & Medicaid Services (“CMS”) expanded access to Medicare telehealth services that made it more convenient and accessible for providers and patients. Under the Section 1135 waiver authority (“Waiver”) and the Coronavirus Preparedness and Response Supplemental Appropriations Act, providers can be reimbursed for patients utilizing telehealth without any geographic or location restrictions starting March 6, 2020 lasting for the duration of the COVID-19 [1] outbreak. Traditionally, patients had to meet the stipulations of residing in a rural area and traveling to a local qualifying site to receive telehealth services. Now, beneficiaries can use telemedicine from their homes or offices while minimizing unnecessary exposure and clogging emergency rooms. Providers can also keep more of their workload by being reimbursed the same as in-person visits, somewhat stabilizing their compensation levels.
Across the telehealth reimbursement landscape, it is worth noting that prior to this Waiver, CMS had already started broadening access to virtual care in 2019. [2] Aside from the traditional telehealth visits that typically required real-time, video interactions in predominantly rural settings, this now included virtual check-ins and E-visits (e.g. five-minute check-in phone calls). These shorter visits can be performed in all areas and settings (i.e. not just rural, remote sites) via telephone or video, and are being accounted for by new Current Procedural Terminology (“CPT”) codes.
These policy changes come as a result of the urgent need across the country to both alleviate the triage and screening burden on emergency room providers as well as to help people who need continual routine care. By keeping more vulnerable patients or patients with potential symptoms in their homes while maintaining access to the care needed, the government hopes to flatten the curve of COVID-19 spread through telemedicine.
In keeping with the mandate of social distancing and widespread lockdowns, the demand for telemedicine services have skyrocketed. Some health care providers are even reducing or waiving out-of-pocket costs and co-pays. In a J.D. Power Survey conducted in 2019, it was found that only 1 in 10 Americans had utilized a telemedicine service for their healthcare needs. [3] Fast forward to the current crisis, and Health systems like the Cleveland Clinic and NYU Langone Health are seeing up to 18-fold daily and monthly increases in their telemedicine visits. Telehealth staffing companies, such as Teladoc, experienced 15,000 daily visits in March, up from 50% in February. [4] Amwell’s patient visits have increased by 257% nationally compared to the same time last year, all signifying the correlation between telemedicine usage and COVID-19’s spread across the country. [5]
According to Dr. Manish Naik, chief medical information technology officer at the Austin Regional Clinic in Texas, “Telemedicine has been on the brink for a while now… and doctors and patients are going to find that when this is all over and the dust settles there are a lot of people who are going to want the telemedicine option to stay.” [6] Although telemedicine options were also made available prior to COVID-19, several factors hindered health systems from fully embracing telemedicine. Amid a fragmented reimbursement landscape, states without payment parity laws do not legally require their private payors to reimburse for telehealth services at the same rate as in-person services. While many private payors still cover telehealth services to some extent, they are often a fraction of in-person services. [7] As of December 2019, only 10 states were found to provide true telehealth payment parity. [8] Given the CMS policy change and the critical need to expand access to care in a lower risk and cost effective manner, private payors are following suit and more providers are signing up to furnish such services.
Another helpful modification is the lifting of barriers for medical professionals to work across state lines. The federal government, in conjunction with many states are waiving certification fees and allowing licensed, out-of-state professionals to provide telehealth services in other states that previously would not have been allowed under the customary guidelines. [9]
Together, these regulatory flexibilities in the interim all contribute greatly to the rapid expansion of telehealth. Aside from telemedicine visits being conducted in the traditional sense (e.g. office visits, mental health counseling), they are also providing innovative solutions for understaffed medical facilities during this pandemic. For instance, LCMC Health in New Orleans recently started screening and treating emergency department (“ED”) patients and outpatients in all specialties via videoconferencing [10]. ED physicians, including those under quarantine can help evaluate patients who have tested positive for COVID-19 through a telehealth visit. These methods help maximize the nation’s workforce while plugging in for provider shortages throughout the country.
The most significant barrier to entry so far is the capability of smaller hospitals and private facilities to adopt telehealth in such short notice. A lack of technology and the learning curve to equip providers on an expedited timeline could cause a delay in telehealth implementation or scale-ups. [11] Should it be successful in alleviating the burden during this crisis, many patients, insurers and health systems are wondering whether the temporary telehealth policies being implemented will extend beyond the COVID-19 outbreak, and if so, to what extent.
As health systems turn to telemedicine as a potential solution during this crisis, it is critical that the contractual agreements being put in place whether for telehealth technology, equipment or physician coverage be structured appropriately. With the expansion of new reimbursement opportunities and the surge in patients leveraging these solutions, health systems with properly established telehealth arrangements are better positioned to combat the COVID-19 pandemic.
[1] “President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak” – CMS, published March 17, 2020
[2] “Medicare Telemedicine Healthcare Provider Fact Sheet” – CMS, published March 17, 2020
[3] “The Coronavirus Has Created A Surge Of Telemedicine Demand. GoodRx Now Lets Consumers Compare Services” – Forbes, published March 26, 2020
[4] “Telemedicine Surges, Fueled by Coronavirus Fears and Shift in Payment Rules” – Kaiser Health News, published March 27, 2020
[5] “The Coronavirus Has Created a Surge of Telemedicine Demand. GoodRX Now Lets Consumers Compare Services” – Forbes, published March 26, 2020
[6] “Telemedicine Surges, Fueled by Coronavirus Fears and Shift in Payment Rules” – Kaiser Health News, published March 27, 2020
[7] Current State Laws & Reimbursement Policies – Center for Connected Health Policy (The National Telehealth Policy Resource Center)
[8] “50-State Survey of Telehealth Commercial Payer Statutes” – Foley & Lardner LLP, published December 2019
[9] “Administration Calls for Expanded Access to NP-provided Care” – American Association of Nurse Practitioners, published March 25, 2020
[10] “Delivering more care remotely will be critical as COVID-19 races through communities” – Association of American Medical Colleges, published March 23, 2020
[11] “Telemedicine during COVID-19: Benefits, limitations, burdens, adaptation” – Healthcare IT News, published March 19, 2020
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