What will Telehealth be like after Covid-19?
The Future of Telemedicine
As a primary care physician caring for adults with developmental disabilities such as autism was my passion for years. Most of my patients were nonverbal adults who often felt overwhelmed by typical clinical or hospital settings. During their childhoods some had difficult encounters in healthcare, developing adverse associations that were hard to erase. Many came to me not just for medical care, but to address behaviors and mental health issues. I worked with families to help devise creative strategies to provide them with medical and psychological care. One such creative solution I proposed at my institution at the time was setting up a telehealth system to help patients whose crippling anxiety of clinical settings prevented them from obtaining much needed medical attention. For years I endured bureaucratic, regulatory and organizational challenges typical of major medical institutions when adopting a new practice model. As such, I was not successful at seeing my telehealth vision for adults with disabilities come to fruition despite finding several low cost, minimally disruptive* solutions. Times have changed significantly since then in the world of telemedicine. In 2020 the Coronavirus pandemic has catapulted the medical profession, and yes, even my very traditional faculty practice at the university, into the acceptance of telehealth.
For now, it seems telemedicine is here to stay. The impact on medical practice of telehealth is significant compared to before the pandemic. It is estimated that virtual health visits could account for approximately 20% of what Medicare, Medicaid and commercial insurers pay for in office, home, outpatient visits, accounting for nearly $250billion in spending. As such, it is important for us as physicians to better understand the regulations that have temporarily been lifted to allow us to practice medicine during the Coronvirus pandemic as well as those regulations which should be reinstated in the future should we decide to continue to practice telehealth. According to the American Medical Association, two examples of sweeping regulatory changes that should be kept permanently are:
1. “Removal of the “originating site” rule so physicians can be paid for a telehealth appointment wherever the patient is, including in the patient's home. Previously, this rule required that the patient live in a rural area and use telehealth at a doctor's office or clinic.”
2. “The near doubling of the number of services covered by Medicare and Medicaid payments to include emergency department visits, initial nursing facility visits and discharges, and therapy services”
One regulatory change that is slightly more controversial is the lifting of HIPAA compliant applications in good faith to connect with patients. Telehealth experts recommend the reversal of this change, since HIPAA compliant apps are available at minimal cost.
If you have already started a telehealth program or are considering starting a telehealth program at your organization, there are a number of resources available to you. For general guidance visit American Medical Association's AMA (AMA Telehealth) and your state Agency for Health Care Administration (Florida AHCA) website. For more detailed guidance, however, it is important to consult your legal and financial team early on to ensure you are following state regulatory and medical malpractice guidelines specific to you (Legal Medical Telehealth Checklist). The Coronavirus pandemic yielded many unexpected outcomes. One positive change was the ability to make telemedicine more readily available to all. Starting a telehealth practice has never been easier, now it is up to us as leaders in healthcare to ensure we are able to continue to practice it long after Covid 19.
Dr. Mavara Mirza-Agrawal, MD, who serves as a special strategy consultant at Healthcare Law Partners, LLC
She can be reached at [email protected]