COVID-19 Brings About Rapid Changes in the Telehealth Landscape

Introduction

The World Health Organization defines telehealth as the delivery of health care services at a distance using electronic means for the diagnosis of treatment, and prevention of disease and injuries, research and evaluation, and education of health care providers.^1,2 Until recently, only 15% of providers reported using telehealth regularly due to self-identified barriers. As Moore et al. point out, more than one-half of family practitioners (FPs) identified lack of training and reimbursement as key barriers to adoption of telehealth, with >40% noting the cost of technology and liability issues as additional barriers.³ During the coronavirus (COVID-19) pandemic, practitioners have been forced to switch to telehealth to provide patients with high-quality care. Nearly overnight, the number of inpatient visits has decreased substantially and telehealth has become the sole means of managing the ever-increasing patient load.

Changes Affecting Reimbursement and Funding

To aid practitioners, a number of health policies and rates have been temporarily altered at both the federal and state level. The Center for Medicare and Medicaid Services (CMS) increased telehealth reimbursement rates from $14–41 to $46–110 per visit.⁴ Aetna, Anthem, Cigna, Humana, and UnitedHealthcare have also announced that they will pay physicians who conduct telehealth visits the same as their face-to-face rate⁵ in addition to paying claims for both in-network and out-of-network physicians. Before these changes, physicians were conducting telehealth visits with little to no reimbursement and as a result were at risk of losing their practices.⁶ Increasing the payout allows physicians a sustainable way to continue to serve critical needs in their community.

In addition, the U.S. Department of Human and Health Services (HHS) awarded 15 million dollars to various programs to increase telehealth capabilities in response to the COVID-19 pandemic. HHS Secretary Alex Azar states that “this new funding from Congress will enable more heroic health professionals on the front lines of the COVID-19 pandemic to use telehealth for a broad range of care,”⁷ as this investment will help train physicians, students, and other professionals who are in high demand. Lack of training was one of the top barriers to FPs using telehealth; this funding will alleviate that problem.³

Audio-only telehealth services are also now being reimbursed, according to the CMS. Prior policy required visits to have both audio and video equipment.⁸ Aetna, Humana, and UnitedHealthcare have also stated that they will temporarily not require a visual connection for proper compensation.⁵ Furthermore, Medicare is also now prepared to allow both new and established patients the ability to have images and videos remotely evaluated. Limitations on the number of times telehealth services can be provided for inpatient visits, skilled nursing facility visits, and critical consult codes have also been modified.^9,10 These changes are important as they allow for heightened patient–physician communication and maintenance of established standards of care.

Changes Affecting Administration of Telehealth Services

Previously, providers were only allowed to administer telehealth visits from a physician’s office or hospital. Moreover, the patient had to be outside of a metropolitan statistical area or in a rural health professional shortage area.¹¹ With current social distancing guidelines in place, many patients are confined to their homes. A patient’s ability to seek care should not be limited by their socioeconomic status or living circumstances and this current waiver change by CMS ensures visits can now be conducted without any limitations.

Conjointly, strict Health Insurance Portability and Accountability Act of 1996 (HIPPA) guidelines have been changed to allow video chat applications (such as Facetime, Facebook Messenger, Zoom, and Skype) to be used to provide care. Under this new waiver, the fear that the office for civil rights may impose a penalty due to noncompliance with the HIPAA rules is not a concern.¹² Another benefit of this change is the reduction in the cost of equipment, formerly rated by 45% of physicians to be a barrier to telehealth.³ In the past, both the physician and the patient had to have access to proper equipment and internet services, the cost of which could be exorbitant with basic units ranging from $799 to $1099.¹³ COVID-19 has created a dire economic climate with 2.4 million Americans filing jobless claims in the past few weeks.¹⁴ This waiver gives both patients and physicians the ability to use a device and software that many already own, thus alleviating both parties’ cost concerns.

The requirement for Medicare and Medicaid that physicians and nonphysicians be licensed in the states in which they are providing services has also been temporarily waived.⁹ In addition, the category of practitioners who can provide and bill for Medicare telehealth services has been expanded to include speech language pathologists, physical therapists, occupational therapists, and several others.⁷ This change ensures that patients can continue to receive 360° care and limits possible attrition due to lack of follow-up. Continuity of care is vital for achieving better health care outcomes, higher satisfaction rates, and increased cost-effectiveness,^15,16 and all these changes will increase the number of patients with access to the care they need.

Conclusions and Recommendations

Many of the aforementioned changes will only last as long as the current public health emergency. COVID-19 has forced a transition into telehealth much faster than we may have liked; however, it has given us a unique opportunity to prove the important role telehealth can play in ensuring that persons of all races, backgrounds, and communities receive high-quality care. The main goal of medicine is to encompass the relief of pain and suffering along with promoting health and the prevention of diseases,¹⁷ and in our opinion it is impossible to do this without telehealth. Making these changes permanent would empower physicians nationwide and aid them in their goal of being effective “physician citizens”¹⁸ in the 21st century. We urge Congress to stand with physicians on the front lines of this fight and make these changes permanent, so that together we can weather the current storm and ensure a brighter tomorrow for future generations of physicians.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.