Telehealth gained significant momentum in 2019. Nevertheless, on an absolute basis, flexible, widely available telehealth solutions were limited. COVID-19 has upended the status quo and charted a new growth trajectory for telehealth(1). In fact, the pandemic has created an opportunity to ingrain telehealth as a commonplace service in U.S. healthcare.
Once COVID-19 started spreading in the U.S., Medicare expanded telehealth coverage(2), Health and Human Services issued guidance to states in favor of relaxing interstate medical licensing rules(3), and 49 states waived or altered regulations on telehealth(4). Waivers included allowing physicians with out-of-state licenses to practice telemedicine within the state, allowing more mediums of communication during a telehealth appointment, and the reduction of regulations on making prescriptions through telehealth appointments. To protect vulnerable populations, elected officials have encouraged and passed legislation in favor of telehealth visits for the elderly and those at higher-risk for COVID-19(5). While many changes are temporary, convenience and increased patient use of the telehealth platforms following the changes has created pressure to permanently adopt the new rules.
Following the forced incorporation of more robust telehealth, the capability to utilize telehealth is growing for patients and providers alike. Patients will welcome the opportunity to see their physicians in person as soon as they’re allowed in order to address more complicated and urgent problems. However, quick health questions and routine consultations are positioned to remain virtual, freeing up patients’ schedules and adding an efficient option for providers. Ready Responders, a tech-enabled, on-demand health service that provides care in a patient’s home, continued serving its patients throughout COVID-19 and announced plans for further expansion(6). Telehealth’s role in companies like Ready Responders can help reduce unnecessary emergency department usage and direct patients more efficiently to proper providers when in-home care is inappropriate, creating promise for potential significant decreases in expenditures while improving care. Furthermore, with provider shortages nationally and in rural areas especially, increased telehealth resources, especially from physicians who might live elsewhere, help bolster access for populations who need healthcare the most.
With elective and non-essential care shut down in most of the U.S., many physician practices began experimenting with telehealth in order to continue to see patients and keep practices running. Largely using live video and audio, patients have discussed symptoms of respiratory infections with primary care physicians, showed dermatologists concerning skin conditions, walked through upcoming procedures with surgeons, and met with mental healthcare providers. Encounters with providers have led to diagnoses and prescriptions, expedited urgent or emergency treatments, and provided plenty of peace of mind. The experience both patients and practices have gained utilizing telehealth in the past few months has created comfort with telehealth that did not exist before the pandemic and lays a foundation for expanded use.
Major hurdles still exist for wider telehealth adoption following the first wave of COVID-19. On the reimbursement front, CMS released new guidelines for reimbursement of telehealth services(7); moreover, private insurance plans are following suit, rewriting policies on what telehealth services they cover and how much is reimbursed(5). Services covered, reimbursement amounts for telehealth vs. in-person services, and the new guidelines’ reimbursement and cost-sharing structures will all determine which services remain viable telehealth offerings for practices. Added time spent arranging telehealth appointments and technology gaps, specifically with patients lacking telecommunication device access or experience, can lower productivity and potentially dampen enthusiasm for future telemedicine use(9). Most importantly, maintaining the ability for physicians and other healthcare providers to practice across state lines following COVID-19 will strongly contribute to telehealth’s potential growth in the coming years(10).
MHT Partners, a leading healthcare services investment bank, believes continued regulatory evolution, demonstrated efficacy and increased efficiency, and consistent and straightforward reimbursement structures are paramount for telehealth to continue its growth and adoption by patients and providers. While telehealth still has plenty of room to grow, 2020 is seeing positive steps towards improving health outcomes, lowering healthcare costs, and increasing healthcare access through innovative telehealth offerings that will continue moving forward. Physician and healthcare practices will need to be increasingly aware of telehealth, know their state’s regulatory environment with regards to telehealth, and have an opinion on whether telehealth presents as an option to best serve their current and future patients.
(1) American Telemedicine Association https://www.americantelemed.org/about-us/
(2) Medicare: Telehealth Coverage https://www.medicare.gov/coverage/telehealth
(3) mHealth Intelligence https://mhealthintelligence.com/news/feds-ok-interstate-licensing-paving-way-for-telehealth-expansion
(4) Federation of State Medical Boards https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf
(5) H.R. 6487 and S. 3548 https://s3.amazonaws.com/fn-document-service/file-by-sha384/fb7696e83acaf7ef91c5a397491226f01ae77205a458e462ecaa875fd31b2152083342720c7e7730e4b661aafa929313 https://s3.amazonaws.com/fn-document-service/file-by-sha384/902177abbfcf26c40e1e793ad5f52cca625fc2b900cdcdd95d8fb23dbc488b8e7898cf74c79592b1bc5ae61fa19898be
(6) Business Wire https://www.businesswire.com/news/home/20200320005540/en/Ready-Responders-Provide-At-Home-Care-Patients-Alleviate
(7) Centers for Medicare & Medicaid Services https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
(8) Kaiser Health News https://khn.org/news/telehealth-will-be-free-no-copays-they-said-but-angry-patients-are-getting-billed/
(9) Policy Med https://www.policymed.com/2020/04/covid-19-recent-changes-to-telehealth-regulations-and-reimbursement.html
(10) Interstate Medical Licensure Compact https://www.imlcc.org/a-faster-pathway-to-physician-licensure/