Telemedicine: here today, here tomorrow?


Social distancing, as crucial as it is, has brought about many new challenges in most every facet of life. But through the uncertainty and unfamiliarity of these current times there has been a silver lining in the healthcare system: the rise of telemedicine. Telemedicine is not a new concept or even a new technology. It just hasn’t been at the forefront of our healthcare system. Like most everything, COVID-19 changed that. Here at Instapath, we have team members who have experienced telemedicine firsthand with their doctors in recent months. Not only did they feel it was convenient, but they felt safe getting the care they needed amid the pandemic. Our team members were not given the option to come into the doctor’s office. Had they been given the option, the group agreed they would have chosen telemedicine. This got us thinking about all the ways telemedicine reigns supreme long-term for both the patient and physician.


In recent years, telemedicine’s growth has been incremental, and used by only 8% of Americans in 2019. A mass migration to telemedicine took place during March and April 2020, co-occurring with a decline of over 80% of in-person visits.1 Before COVID-19, even health systems with relatively high telehealth adoption performed fewer than 100 video visits per day. Now, many are seeing > 600 patients per day via video; with many in-person clinics replaced with video or telephone visits. At Duke University’s School of Medicine, the share of telehealth visits increased within a 4-week period from <1% of total visits to 70% of total visits, reaching over 1000 video visits per day.2 We interviewed Dr. Mark Lewis, Director of Gastrointestinal Oncology at Intermountain Healthcare in Utah. “I’ve moved about one-third of my patients to telehealth,” he told us. The remaining two-thirds of his patients are required to have in-office visits (ex. patients receiving chemotherapy). “When patients have the option, about 85%-90% choose the telehealth appointment. For the 10% that come to see me in person, they do so because they don’t want to potentially miss anything. And, the pandemic is so isolating; some patients just want to see another person,” he explained. To further provide safe and convenient care for his patients, they started a new pilot project: administering immunotherapy in patients’ homes with a visiting nurse, while he conducts his appointments with these patients via telehealth. Think about that. These patients don’t have to worry about leaving their homes, finding transportation, maneuvering through traffic to meet an appointment time, paying for parking at the clinic, finding a parking space - the list keeps going. Patients can focus their energy on healing in their homes. “The patients love it,” Dr. Lewis reported. He believes treating patients as much as they can at home is here to stay.


With technology such a prevalent part of our lives, it’s interesting that telehealth hasn’t been this widely used before. Why did it take a public health emergency to realize the opportunities and benefits of telemedicine? Key barriers to wider adoption have included limited reimbursement, lack of comfort with telemedicine technologies by patients and providers, and fundamentally, outside of rural medicine, few compelling cases for the replacement of in-person care.1 With the rapid spread of coronavirus as the compelling case, if patients wanted to receive care safely, and if physicians wanted to provide care safely, telemedicine became the answer. Looking past this pandemic, will telemedicine remain the answer? We believe so.


Until the recent change in telemedicine accessibility brought about by the COVID-19 pandemic, telemedicine reimbursement had been hindered by geographic restrictions, narrow coverage policies, and a lack of payment parity. As telehealth services have become more widespread in the consumer healthcare space, sustainable payment policies from public and private payers are critical to the ongoing growth and development of telemedicine. Regulatory policy, in general, tends to lag behind advancements in technological capability, and telemedicine is no exception. Payment models have not kept pace with the rapid expansion of telemedicine technology and scope, and a 2019 report from telemedicine provider American Well revealed that the top concern of clinicians pertaining to telemedicine adoption is uncertainty about reimbursement.3


As a result of the COVID-19 pandemic, reimbursement requirements have been relaxed. Effective March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) expanded access to Medicare telehealth services under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. The 1135 waiver allowed reimbursement for professional fees for telehealth visits occurring at any location, including a patient’s home. In addition, CMS has waived the rural geographic restriction. Two new Current Procedural Terminology codes were created for billing of virtual visits via telephone. Providers were also instructed that certain regulations would not be enforced as not to be obstructive to optimal patient care during this global health crisis. Per the Department of Health and Human Services (HHS), audits to ensure a prior relationship existed for telehealth claims will not be conducted and the HHS Office for Civil Rights will waive penalties for Health Insurance Portability and Accountability Act (HIPAA) violations that occur in good faith with common communication technologies.4 Non-HIPAA compliance tools such as FaceTime, Zoom, Cisco Webex, and Skype are now approved to be temporarily used in telemedicine. Although, Facebook Live or TikTok cannot be used for telemedicine.5


While short-term, there are some downsides for physicians: reimbursement and lost revenue. Regarding reimbursement, we hope the relaxed restrictions by CMS and HHS will remain in place now that we’ve experienced the benefits and viability of telemedicine. Currently, revenue-generating tests and exams, which are conducted while patients are in-office, have taken a backseat. However, when patients can return to their doctor’s office safely and social distancing is no longer in effect, those tests and exams will resume as will the revenue stream.


Long-term, telemedicine can be a large generator of revenue. Not only can physicians “see” more patients in a day, they can allocate their resources and the resources of their staff appropriately to the patients who need to come into the office for an appointment versus patients who can be treated virtually. A benefit for both patients and physicians is that telemedicine allows physicians to see patients anytime and anywhere - this includes evenings, early mornings and weekends. This offers huge flexibility for patients who can now squeeze in that doctor’s appointment during their lunch hour, or for the stay-at-home parents who can’t leave their children. Patients may be more likely to be on time for their appointments and may be less likely to miss appointments because childcare, transportation, work, traffic, weather, etc. are no longer barriers to getting to the doctor’s office by a set time.


This pandemic has hurdled us into a virtual reality with meetings, conferences, book clubs and even dating being moved to online formats. To survive and thrive in this new virtual world, individuals had to learn how to use technologies they were previously unfamiliar with. If you hadn’t used Zoom or WebEx before, you probably have now! We are prepared now, more than ever, to take advantage of telemedicine. The benefits of telemedicine will not end once the pandemic ends. Telemedicine will remain a convenient, flexible, cost-effective option for patients and physicians post-coronavirus. We hope lessons learned during this pandemic will not be forgotten and the relaxed restrictions by CMS and HHS will remain in place now that both patients and physicians have experienced the benefits and viability of telemedicine. What do you think -- is telemedicine here to stay?


Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit www.instapathbio.com or contact us at info@instapathbio.com.


References

1 Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132-1135.


2 Wosik J, Fudim M, Cameron B, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-962.


3 Bajowala SS, Milosch J, Bansal C. Telemedicine Pays: Billing and Coding Update. Curr Allergy Asthma Rep. 2020;20(10):60. Published 2020 Jul 27.


4 Thota, Ramya, Gill, David M., Brant, Jamie L., Yeatman, Timothy J., and Haslem, Derrick S. Telehealth Is a Sustainable Population Health Strategy to Lower Costs and Increase Quality of Health Care in Rural Utah. JCO Oncology Practice 2020 16:7, e557-e562.


5 Bokolo Anthony Jnr. Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic. J Med Syst. 2020;44(7):132. Published 2020 Jun 15.

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