How Has Coronavirus Impacted the Field of
Authored by Ayesha Rajan, Research Analyst at VIKRITI Management Consulting
Telemedicine has been a health delivery option for more than 10 years that has never lived up to its promise. There are a variety of reasons for this, from infrastructure and connectivity issues to a wide disparity of patient technical skills but perhaps the most limiting factor has been payer reimbursement. For years both CMS and private payers have been unwilling to reimburse for any but a narrow set of services. Fortunately, with the increased concerns brought by Covid-19 for in-person patient visits, these restrictions are changing. The question now becomes, what does this mean for the future of telemedicine?
Covid-19 has forced many practitioners to temporarily shift their practices online using video conferencing applications like Zoom. Dr. Joseph Kvedar of Harvard Medical School says that health networks in New York City have gone from 0 to up to 5,5000 online visits per day since the Covid-19 pandemic began (Kaiser Health News). However, many physicians may not see this shift as a temporary one. Medicare consultant Seema Verma has praised telemedicine for its ability to help patients outside of a pandemic by limiting the interaction of someone with flu-like symptoms with others in a waiting room or saving elderly patients a trip that could compromise their immune system. This means that telemedicine will have an important role in medicine long after Covid-19 is only a memory because of the other numerous benefits and, as Dr. Manish Naik (CMO at Austin Regional Clinic) points out, “there are a lot of people who are going to want the telemedicine option to stay” (Kaiser Health News). While telemedicine may not have previously been a viable option for many practices, the increase in technology services and tools in recent years has made its success very possible in 2020. CNBC reports that “PC [sales] have grown by at least 30% each of the last five weeks, Chromebook sales have been up over 100% for each of those weeks [and] Windows sales up 45% for the last five weeks”; this tells us that more people than ever are computer owners. Furthermore, the report states that “nearly all the growth in broadband usage we would have expected for 2020 has now been achieved in the first quarter, with much of it concentrated in the last two weeks of the quarter,” telling us that as the pandemic began and stay at home orders were being placed, people were using the internet more than ever (Novet).
Changes in Rules and Regulations
Since Covid-19 began limiting in person appointments, CMS has significantly expanded its list of covered telehealth services to include emergency visits, initial nursing facility and discharge visits, home visits and therapy services (HHS). It has also initiated policy changes such as allowing the practice of telehealth across state lines, and the ability to delivery many services routinely only allowed as in-person visits, now are being allowed for telemedicine as though they are in-person services.. These policy changes also make it easier for people to enroll in Medicare, Medicaid and Children’s Health Insurance programs (CHIPS) (HHS). All of these policy changes are temporary and meant only to last the duration of the pandemic, however, it is possible that many of them could be reintroduced as permanent policy changes given the number of patients and physicians alike can see the benefits of telemedicine.
The University of Arizona’s Telemedicine Program has a lot experience in this area and has identified a few problems – the first issue at hand is how to bill telemedicine. Currently, Medicare only covers telemedicine for patients with conditions that have persisted for one year but may not cover a telemedicine visit for a patient hoping to be seen efficiently for a general wellness check-up. Another issue that telemedicine faces is continuity across the Electronic Health Record systems; this means that the addition of a telemedicine option may not compatible with established workflow and can prevent physicians from keeping detailed records or can provide issues if a patient chooses to see a different physician and their original physician does not have enough collected information for the case at hand (Varshneya). There are also issues regarding a patient’s ability to use a software they are unfamiliar with and issue of privacy even if a network is highly secure. Finally, a patient’s inability to describe a physical issue accurately and a doctor’s inability to see things in person means that there is a higher chance of misdiagnosis with telemedicine services.
Telemedicine is a powerful tool that has several benefits and challenges. While it is not the right option for everyone, it is a great option for some. The Covid-19 pandemic has forced providers to consider telemedicine as a viable option and has proven that the United States has the infrastructure to keep telemedicine as an available option for several patients seeking physical or mental health consultations. It is also the first time that the need for telemedicine has coincided so well with a time period in which technology and internet services are so widely accessible. The benefits and challenges of telemedicine are mostly unique to an individual patient, healthcare needs and preferences. A surprising piece of information that may have not even crossed your mind – many veterinary practices are also expanding their telemedicine services to be able to check in on pets while practicing social distancing!
Galewitz, Phil. “Telemedicine Surges, Fueled By Coronavirus Fears And Shift In Payment Rules.” Kaiser Health News, 27 Mar. 2020, khn.org/news/telemedicine-surges-fueled-by-coronavirus-fears-and-shift-in-payment-rules/.
HHS Office, and Public Affairs. “Telehealth: Delivering Care Safely During COVID-19.” HHS.gov, US Department of Health and Human Services, 7 May 2020, www.hhs.gov/coronavirus/telehealth/index.html.
Novet, Jordan. “The PC Is Suddenly Cool Again … for Now.” CNBC, CNBC, 4 May 2020, www.cnbc.com/2020/05/04/pc-sales-usage-rise-during-coronavirus-lockdown.html.
Schulte, Fred. “Coronavirus Fuels Explosive Growth In Telehealth ― And Concern About Fraud.” Kaiser Health News, 22 Apr. 2020, khn.org/news/coronavirus-fuels-explosive-growth-in-telehealth-%E2%80%95-and-concern-about-fraud/.
Varshneya, Rahul. “7 Telemedicine Concerns and How to Overcome Them.” 7 Telemedicine Concerns and How to Overcome Them, 2018, telemedicine.arizona.edu/blog/7-telemedicine-concerns-and-how-overcome-them.