Emergency Measures Spur Growth of Telemedicine for Coronavirus, but What Comes Afterward?
Amidst the apprehension wrought by the current COVID-19 pandemic, a silver lining has emerged: Primary care providers (PCP) are finding that telemedicine usage within their practices, previously hindered by issues such as inadequate reimbursement, privacy concerns, and costs, has begun soaring as cautious consumers seek alternatives to visiting the doctor’s office in person and, thus, potentially exposing themselves or others to COVID-19. Industry analysts are predicting that as both providers and patients embrace telemedicine for coronavirus as a solution for reducing the risk of transmission of infectious disease, as well as for other ailments, they will become accustomed to telemedicine as a tool and will expect its continuation within medical practices. As a result, the current shift in healthcare delivery towards virtual care—i.e., beyond a facility’s walls—will make large strides as lower acuity patients remain at home or work during consultations, thereby freeing in-office time slots for the sickest patients. In essence, the COVID-19 pandemic is proving to be a stronger impetus than almost any other single factor in urging the rapid adoption of telemedicine. Whether the momentum will continue after the pandemic remains to be seen.
Telemedicine itself isn’t new; first developed by the National Aeronautics and Space Administration (NASA) and the Nebraska Psychology Institute, now known as the Munroe-Meyer Institute, in the late 1960s to serve astronauts in space, the technology received modest attention for decades—until the relatively recent push for value-based care prodded health providers to seek alternate methods of health care delivery. Generally, the growth of telemedicine in the medical field has been stifled by such challenges as regulatory, financial, and technological obstacles. In 2009, new federal legislation encouraged the integration of telemedicine technology into care coordination, but medical facilities ran into the same old problems: outdated regulatory standards, insufficient broadband networks, inadequate reimbursement, and shareholders’ reluctance to change the business model—all of which, combined, often made the move financially unviable.
Enter COVID-19. This vile virus has spread extremely rapidly from its first appearance in Wuhan, a Chinese city south of Beijing, to its pandemic status a few months later. Concerned about transmission through human contact, governments across the world have enacted physical isolation and social distancing requirements in order to reduce or slow the spread of this contagious illness. Under these circumstances, new questions emerged: Should a sick patient who might have contracted COVID-19 travel to a medical facility or physician’s office—and in doing so, expose staff and other patients to the virus? From a public health standpoint, the answer is a resounding “No.” How, then, can this patient population access the medical care they need?
Suddenly, telemedicine started looking a lot more attractive and a lot less troublesome. Quick action by legislatures partially eased some of the most obstructive regulations, including Health Insurance Portability and Accountability Act (HIPAA) requirements for privacy and security, reimbursement by Medicare, and whether new patient intake can be conducted through a telemedicine visit. As a result, medical facilities and hospitals are reporting exponential growth in the use of telemedicine for coronavirus. For instance, Novant Health in North Carolina recorded an increase from 200 telemedicine visits per week to over 12,000 visits in one week.
Patients are also setting aside their doubts to embrace this strategy; previously unconvinced, this population is finding that with the shelter-in-place order, telemedicine for coronavirus, or for more common low-acuity issues, may be their only viable option for seeking and receiving medical care.
Andrew Watson, a vice president at the University of Pittsburgh Medical Center and a former president of the American Telemedicine Association, predicts that the forced adoption of telemedicine will show providers that in-person encounters are not as essential to care delivery as many believe. With this hurdle overcome, more providers will transition to telemedicine for coronavirus and other, more common issues. Jeff Wessler, CEO of Heartbeat Health, a cardiology technology company, agrees; he expects that the rapid adoption of telemedicine will prove its value to skeptics.
Meanwhile, telemedicine proponents have already begun their efforts to cement the current measures beyond the ongoing emergency situation; bipartisan supporters in Congress are urging broader coverage of telemedicine and remote patient monitoring. Even with legislative support, however, several adjustments will be required before telemedicine for coronavirus, for additional infectious diseases, and other ailments can become an integral component of care delivery. For instance, in the current pandemic, HIPAA enforcement has been lightened to clear the way for more providers to see more patients. In the long run, HIPAA will once again take effect in full, and telemedicine vendors who wish to remain relevant should act now to ensure their systems are HIPAA-compliant.
Some industry watchers fear that reimbursement rates and licensing requirements will return to their previous levels after the emergency period has passed. For instance, Medicare’s new policy of payment parity for telemedicine—reimbursing for telemedicine care at the same rate as in-office care—stands on particularly shaky ground. One possible solution, presented by technology consultant Grady Gibbs, suggests that providers who offer telemedicine as a secondary service for existing patients’ convenience could be reimbursed at a higher rate than a company whose primary function is to direct patients to online providers. With the latter approach, the provider and patient are strangers. In the former scenario, telemedicine is used as one of many tools to help patients continue healthcare with an established PCP. This two-tier proposal is intended to preserve the stability of PCPs by enabling them to remain the patients’ point of contact for seeking care and to expand their practices to include telemedicine.
Overall, the uncertainty surrounding telemedicine’s permanence post-COVID-19 is neatly summed up by Christine Calouro, a Center for Connected Health Policy associate and telehealth expert: “I believe everything I have seen thus far has been temporary and time-limited to the COVID-19 emergency, which means theoretically all the policies will go back to their pre-COVID-19 status after all this is over. But it’s also possible that the policies get extended, or the original policies are amended, as people get more used to using telehealth and it becomes more integrated into care delivery due to this virus.”
