Coronavirus Impacts on Patient Care – Part 2

covidputerEncouraging patients to avoid coming into the health care facility or hospital has been a boon for the uptake of telehealth services. There has been an unprecedented surge in demand for remote health care, with one U.S. provider, Teladoc, reporting that remote medical appointments have more than doubled since early March, to over 20,000 virtual medical visits a day by mid-April. Teladoc now anticipates their Q1 revenues will exceed $180 million, boosted by these visits, an increase of more than 40% from the first quarter of 2019.

 

Physicians, health systems, and medical groups are embracing virtual health care at a level not seen prior to COVID-19. Analysts now expect virtual general medical care visits to top 200 million this year, up sharply from their original expectation of 36 million visits for all of 2020. Before now, adoption of telehealth and virtual medical care was slow, for a number of reasons. The technology was expensive and required training, and there were legal concerns about privacy, liability, licensing and security. The biggest barrier to adoption, however, was reimbursement. Only 10 states required equal reimbursement for both remote and in-person visits. In March, the situation changed, as federal policy makers greatly opened up access to telehealth services, and the Centers for Medicare and Medicaid Services eliminated barriers to use of telemedicine for Medicare patients by allowing both virtual and in-office visits to be reimbursed at the same rate. State programs and private insurers quickly followed to facilitate telemedicine’s increased use. As a result, the COVID-19 pandemic made what had been a years-long process of telemedicine adoption happen within a matter of weeks.

 

In Massachusetts, the state’s Medicaid and Children’s Health Insurance Program — MassHealth — has partnered with Maven, the largest telemedicine provider of services for women’s and family health, to offer free telemedicine appointments for its members. This program is particularly valuable for women who are managing a high-risk pregnancy or who have recently given birth and need assistance caring for a newborn. Telehealth enables these women and families to receive the support and care they need from the safety of their own homes.

 

Some patients in need of dental services are also benefiting from the rise of telehealth. Major insurer Cigna is offering emergency dental consults via telemedicine, enabling dentists in their own system as well as the 300 dentist network, The Teledentists, to triage urgent patient issues such as pain, infection or swelling and prescribe pain medications or antibiotics as appropriate.

 

Walgreens has also introduced new telehealth resources that allow patients to consult virtually with over 30 providers who treat more than 100 medical conditions, as well as a digital COVID-19 risk assessment tool and a “Find My Clinical Trial” program.

 

According to a survey by CircleSquare, physician telehealth adoption is up 340% from 2015, when only 5% of physicians reported having ever used telemedicine. Doctors are increasingly seeing the advantages of this way of caring for their patients, as it encourages some patients to more readily seek care by removing the financial and travel burdens of in-office visits. And many patients like the opportunity to see their doctor without potentially exposing themselves or their families to infection risk. At the same time, telemedicine has important limitations, precluding the types of health evaluations that require assessment by “feel,” such as a doctor feeling a patient’s throat for thyroid nodules. 

 

One of the barriers to greater use of telemedicine has been the difficulty and expense of doctors gaining credentials in multiple states. As each state has its own process, the process of credentialing for telemedicine is not yet well defined. The Federation of State Medical Boards (FSMB) has offered assistance to help expedite verifying licenses and credentials of providers and other healthcare professionals who wish to practice across state lines, and other professional groups have begun to address this issue as well. Developing a more standardized credentialing process for telemedicine could make it easier for fully credentialed physicians to more seamlessly see patients whenever care is needed, and would likely result in further growth of this sort of patient care.