A mother, torn between her worry over her young son’s rash and the fear of leaving isolation, finds solace in a phone consultation with a pediatrician. A confirmed COVID-19 patient quarantines at home, knowing that his texted check-ins with his primary care physician will help him get car without putting others at risk. An elderly diabetes patient finds answers about her new medication by talking to her endocrinologist through the same video conference platform she uses to speak to her grandchildren.
Telemedicine has proven itself a godsend for a population living in anxious isolation. Over the last several weeks, over 316 million people have retreated to their homes in an attempt to slow the spread of COVID-19. The pandemic threat has prompted federal and state governments to temporarily allow patients unprecedented access to telemedicine — but for how long? Even as temporary legislation allows for greater digital health solutions, providers and patients alike worry that their easy access to telehealth solutions might disappear with COVID-19.
Telemedicine has seen a sharp rise in popularity since the start of the pandemic. According to a recent report from Kaiser Health News, the Cleveland Clinic logged more than 60,000 telemedicine consults in March, a 17-fold increase of their usual 3,400 monthly virtual visits. Digital health provider Amwell similarly reports that usage of its app has increased 158 percent nationwide and an unprecedented 658 percent in Washington state, an early COVID-19 hotspot.
This uptick is a financial liferaft for providers, given the sharp decline of primary care visits. According to a recent survey by the Medical Group Management Association (MGMA), 97 percent of physician practices nationwide have experienced a negative financial impact directly or indirectly due to COVID-19. MGMA further reports that physician practices have, on average, seen patient volume fall by 60 percent and revenue drop by 55 percent. Desperate providers and patients have turned in droves to telemedicine, hoping that digital healthcare solutions could both provide business support to providers and allow isolated patients to safely seek much-needed care.
Prior to COVID-19, facilitating and accessing digital care was notably difficult. Historically, providers have struggled to achieve pay parity between virtual and in-person visits, with telemedicine reimbursed at a fraction of what a conventional appointment might have earned. Payment policies for telemedicine varied widely across state and private-payer lines; as of last November, only six states had commercial payer parity laws in place. Many states also made reimbursement contingent on where the patient receives telehealth services. As of 2018, only 13 states allowed the home and 15 states permit schools to serve as originating sites for telehealth. The majority did not reimburse for home-based telehealth services.
Licensing, too, was time- and resource-intensive. States typically required providers to have a license in the state where their patients receive care. As of 2018, only nine offered special telehealth licenses that allowed for cross-state care. Obtaining multiple licenses was — and still is — a time- and cost-prohibitive process, especially for smaller organizations with limited resources.
In light of COVID-19, however, the Center for Medicare & Medicaid Services (CMS) made sweeping allowances for telemedicine. In April, the agency added 85 telehealth services to the list of those covered by Medicare, including emergency department visits, home visits, and therapy services. Providers will also be allowed to evaluate patients over the phone and provide care without a video connection, as well as via commercially-available interactive apps from home. These changes have empowered patients and providers to vault the challenges that previously barred easy access to telemedicine — and demonstrated the value that digitally-facilitated care could provide to patients and providers alike.
However, the potential of this telehealth expansion has been constrained by uncertainty. Providers and patients don’t know how long this easy access to telemedicine will last, or when the historic barriers will be reinstated. This uncertainty prevents them from investing in telemedicine to its full potential — or trying in earnest to fix its flaws.
The implementation of digital health solutions for COVID-19 hasn’t been perfect. While CMS’ announcement has been helpful, it only addresses Medicare patients. Commercially-insured patients are subject to a patchwork of state parity laws and regulations. While several states have followed CMS’ example and mandated parity for commercial insurers, the inconsistency has been frustrating and harmful to health businesses. MedPage Today noted that many care providers find the telehealth bills that were supposed to be reimbursed on par with conventional visits only partially paid.
COVID-19 has given us the priceless opportunity to trial telemedicine on a national scale and has demonstrated that digital health solutions can have a valuable place in our everyday lives. While both providers and patients have embraced the value of digital health solutions, they have no way of knowing which pandemic-prompted changes to regulations will be permanent, and which will fade in 60 days. Let us permanently lower the barriers to access, clarify our long term reimbursement policies and give society confidence that patients can continue to see their doctors be it in the office or on a screen.