Today, most healthcare providers are viewing telehealth as a critical tool in the fight against COVID-19. Telehealth offers providers the ability to maintain continuity of care with patients, while preserving revenues, in this new age of social distancing.
“Clinics that have no virtual capability whatsoever … have seen volume go down 40, 50, 60 percent,” Privia Health CEO Shawn Morris told Modern Healthcare. At this rate, independent providers can find themselves in “a negative cash flow position really quick.”
In response to the pandemic, the Centers for Medicare and Medicaid Services (CMS) have relaxed and/or waived various regulations that have traditionally limited the applicability and use of telehealth. Commercial payers have largely followed suit.
We’ve assembled below a brief primer on the recent changes from CMS, along with observations and lessons learned “from the frontlines” to help independent providers adopt and scale the use of telehealth.
COVID-19 Rewrites the Rulebook on Telehealth
The social distancing measures needed to “flatten the curve” and slow the spread of COVID-19 create a challenge: patients need care, but are instructed to stay at home. Many of the archaic regulations that limit the use of telehealth have been waived and new guidance has been issued to allow for rapid adoption of virtual care models.
- Reimburse at the same rate as in-person visits. CMS will now reimburse a telehealth visit at the same rate as an in-person visit. In an official press release, CMS issued waivers allowing “providers [to] bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth.”
- Increase applicability of telehealth. Providers can now treat both “new as well as established patients,” who are free to “stay at home and have a telehealth visit with their provider.” In addition, CMS has expanded the list of applicable telehealth services to include “more than 80 additional services [CPTs] to be furnished via telehealth” in order to better meet the needs of patients and providers.
- Reduce technology barriers. To speed up adoption of telehealth, HHS has instructed authorities to temporarily “waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype.”
- Reduce administrative barriers. CMS will “temporarily waive Medicare and Medicaid’s requirements that physicians and non-physician practitioners be licensed in the state where they are providing services. State requirements will still apply.” In response, many states have followed suit. “As part of emergency declarations, many governors have relaxed licensure requirements related to physicians licensed in another state and retired or clinically inactive physicians,” the American Medical Association (AMA) reported. The Federation of State Medical Boards assembled a helpful guide to individual states’ modified requirements. CMS also added a “toll-free hotline” for providers “to enroll and receive temporary Medicare billing privileges” to “allow practitioners to render telehealth services from their home.”
Together, these waivers and notices of enforcement discretion have allowed for a quick glide path to providers’ adoption and everyday use of telehealth. “Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly,” Verma said.
3 Lessons COVID-19 Teaches Us About Telehealth
First, healthcare providers are recognizing that care delivered via telehealth can be equally as effective as in-person care when used appropriately. This has typically been one of the many long-held myths that have deterred providers from adopting the technology. In this time of social distancing, telehealth plays a critical role in our collective frontline battle against the spread of COVID-19. Healthcare providers’ ability to triage and care for patients remotely helps prevent sick or asymptomatic patients from spreading the disease to their providers, to clinical staff, or to other patients who may truly require in-person care.
Second, when healthcare incentives and regulations are aligned, value is created for patients. Prior to COVID-19, providers were hamstrung by outdated telehealth regulations. In order to compliantly use and bill for telehealth services, onerous “originating site” requirements needed to be met by the patient and treating provider. Reimbursement was varied and uncertain. Today, CMS and most private payers have given providers the freedom and flexibility to decide when and how to utilize telehealth technology in the manner most effective for advancing patient care.
“None of us anticipated … the transition to almost 100 percent virtual visits, and how much the practice of medicine could be accomplished in our parking lot,” Sumi Sexton, MD, a Privia physician, wrote for American Family Physician.
Third, not all telehealth platforms are created equal. There are myriad telehealth platform options available to providers today. Within the past few weeks, numerous new products have come onto the market (every tech company seems to be jumping on the telehealth bandwagon right now). HHS has further muddied the waters with the recent temporary waiver of HIPAA violation penalties for using a non-secure platform such as FaceTime or Skype. What separates a good platform from a mediocre or poor platform? The easy answer, particularly now given the financial pressures facing providers, is to select the cheapest — or free — platform available. Basing on a platform decision on cost alone may seem enticing in the immediate term, but will likely lead to big headaches over the long-term.
Evaluating Telehealth Platforms
At Privia Health, we’ve trained and implemented more than 2,000 providers across 25 specialties onto our telehealth platform. Collectively, these providers have completed more than 100,000 telehealth visits.
Based on this experience and many lessons learned, here are three important considerations when selecting a telehealth platform:
- Flexibility. Once you have mastered the basics of a telehealth visit, you will quickly want (and your patients will demand) more advanced and varied workflows. Ensure the platform you select supports a wide variety of use cases, including scheduled visits, on-demand visits, urgent care visits, group visits, and more. Further, make sure that the platform you select is supported on both desktop and mobile devices.
- Integration and Security. Don’t try to force a square peg into a round hole. In other words, make sure the telehealth platform you select integrates seamlessly into your existing patient and office workflows. Telehealth should be easy to adopt. If it isn’t, then you have probably selected the wrong platform for your needs. Remember, telehealth is just another tool at your disposal, like a stethoscope or an EHR. Ultimately, it needs to fit within your practice’s “toolkit.” Finally, don’t put your patients’ information at risk. Get a HIPAA-compliant platform.
- Training and Support. Technology is only half the battle. People and processes ultimately drive the success of telehealth. Look for a platform that offers consultative support, turnkey implementation, and training programs that fit your needs. In our own experience, and as reported by Rachel Woods for the Advisory Board, “Privia realized that everyone learns differently and sometimes it takes repetition for change to take place. As such, the medical group gave providers the option to participate in 1:1 virtual trainings, daily group webinar-based trainings, and/or self-training through online tutorials, videos, and collateral. All virtual trainings are available after hours and on weekends.”
Telehealth adoption has been slowly gaining ground in recent years, but COVID-19 and social distancing have now catapulted telehealth into mainstream care delivery almost overnight. It’s hard to imagine a post-COVID-19 world not including telehealth as a standard part of physician practice. Those providers who decide not to adopt telehealth, or are late to adopt, will most likely get left behind and will ultimately be at a big competitive disadvantage.