The role of telehealth
amid the coronavirus pandemic

In a world where social distancing is the responsible thing to do, telehealth can play an important role.

Currently, the United States is taking ever-increasing measures to “flatten the curve” of the COVID-19 outbreak to avoid the experiences of counties that are further along in the cycle and are facing hard choices. While the victims of COVID-19, in most cases, will make a full recovery, those with serious, even life-threatening, cases could overwhelm the health system in the United States, as is currently happening in Italy, where healthcare rationing has been introduced.

Telehealth can help ease the burden

What is telehealth? It’s interacting with a health professional using technology, such as a videoconference. Clinicians can diagnose many medical problems using videoconferencing and—in some cases—can even “listen” through an electronic stethoscope. Of course, a videoconference can never replace a doctor’s complete physical examination, such as touching a distended stomach, when such signs are present.
Telehealth services are not new but have been of limited use because of a number of constraints. Dr. Joe McMenamin, of McMenamin Law Offices, a doctor, and general counsel for the Virginia Telehealth Network, explains the advantages of telehealth and how COVID-19-focused changes to the law have opened this option up to many more people.
At first blush, telehealth may not sound particularly valuable during a pandemic involving a virus that in some respects mimics the SARS virus or other less exotic ailments, but telehealth can still play a major role in easing the burden on the healthcare system during this crisis. For example, McMenamin explains, people with other medical needs, such as a sprained ankle, can use a telehealth solution and accomplish two important goals—keep themselves out of hospitals or other clinical settings, where they could pick up the virus, and lessen the strain on the healthcare system. Of course, sometimes the doctor’s advice might be to be seen in person, but many times an in-person visit is not necessary.
Even for patients who have flu-like symptoms, a video conference may be the best first-line approach. Again, it keeps already sick patients away from a hospital or clinic where infectious diseases can be contracted, while still providing them with a professional opinion about what steps they should be taking. It also keeps contagious patients at home, whenever possible, so they are not spreading microbial pathogens in their search for medical care or testing, McMenamin says. (It must be acknowledged, however, that telehealth by itself does not permit identification of a causative organism. That requires a culture of biologic fluids, and providing samples from a distance is cumbersome. Culture results may be important for identifying patients who do and do not need antimicrobial medicines.)
Distance care can also be a force multiplier, enabling providers to see more patients at a time when the supply of medical professionals lags demand. In certain specialties, the quality of care may actually be better than it is in person. A good example is psychiatry, in which some patients, especially young people, are more comfortable discussing sensitive topics through an electronic medium than in person.
Despite these potential advantages, telehealth usage has been highly restricted largely due to government regulations and third-party payors’ policy restrictions. Generally, the concern has been cost and overuse, McMenamin said. For example, while a videoconference is typically less expensive than an in-person visit, regulators worry that patients who used video chats might still feel the need to visit a doctor’s office or the hospital, effectively being diagnosed twice and adding to costs. Likewise, payors are concerned that arranging a teleconference is usually much easier and more convenient than making a doctor’s appointment, which might encourage overuse. As a result, regulators put significant reimbursement restrictions around telehealth, which in many instances limited its availability to groups with special needs, such as those in rural areas who are unable to transport themselves to medical facilities, which created an obstacle to the expansion of telehealth, McMenamin explained. Likewise, many, though by no means all, private insurance companies have restricted or largely prevented reimbursement of telehealth, as well.

COVID-19 changed all that

On March 6, 2020, the bipartisan Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 became law. Within this law is the Telehealth Services During Certain Emergency Periods Act of 2020, which allows Medicare recipients to access telehealth options with far fewer restrictions, McMenamin says. (Medicaid recipients have different rules that vary by state.) While there are still some restrictions, the bill allows Medicare beneficiaries across the country, even those in urban areas, to receive telehealth services via their smartphones or other devices. Additionally, the government recently announced that, in the exercise of enforcement discretion, it would not police the rule that the provider must have billed Medicare for services to the patient within the previous three years.
Likewise, commercial insurance companies are also expanding telehealth services access, some are even temporarily covering telehealth at the same rate as in-person office visits—and this access is likely to expand due to government urging. For example, on March 15, Massachusetts Gov. Charlie Baker mandated that commercial insurers cover medically necessary telehealth services to help keep patients with acute illnesses out of the hospital during the current crisis. While, like everything associated with COVID-19, particulars are highly fluid, currently Oregon, California, New York, Georgia, Maryland and Washington are now requiring commercial carriers to waive deductibles, co-insurance and co-pays. (For those falling under ERISA jurisdiction, however, states do not have the authority to require self-insured plans to cover benefits.)

What’s next for telehealth?

While the March 6 changes were presented as a “waiver” specifically for the COVID-19 emergency, McMenamin hopes these eased regulations will essentially provide a trial run for permanent changes from regulators and private insurance companies.
“This is an opportunity. With more widespread use during the virus outbreak, telehealth has the opportunity to prove its value. Telemedicine is a tool—in the right setting it’s excellent, in the wrong one it’s not. If we know its limits and use it appropriately, telehealth can ease burdens on the healthcare system long after COVID-19 moves out of the spotlight,” McMenamin explains.
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