Utilization of Telehealth in the Age of COVID19

In early 2020, the world was hit with the devastating news of a novel coronavirus disease (COVID-19) that caused a pandemic. During the COVID-19 Public Health Emergency (PHE), healthcare organizations had to grapple with the challenge of providing care to a socially distanced society in an attempt to reduce the transmission of disease, preserve the limited personal protective equipment (PPE) available, and minimize exposure to patients, providers, and the community. The PHE provided an opportunity for telehealth services to gain traction as previous restrictions on providing telehealth services were lifted to reduce barriers to healthcare access.

The healthcare sector looked to telehealth technical platforms to continue to delivery of care to the community under a lockdown. Telehealth refers to the entire spectrum of activities used to deliver care at a distance without direct physical contact with the patient.

Telehealth was effective in care delivery in various non-emergent medical scenarios. A sizeable proportion of outpatient care was managed effectively remotely. Patients with non-urgent conditions got to see their healthcare provider through telehealth services.

The required infrastructure for connectivity to this platform already existed in major healthcare organizations but had limited use (mostly specialized care). Hospitals with the help of a government waiver expanded these services to other departments in their organization to continue providing care during the pandemic. The proliferation of smartphones, wearable devices, and other forms of healthcare technology made this transition possible. However, broadband internet access was a problem faced by patients who were scheduled for virtual visits. Without the necessary technology, accessing telehealth services is challenging, if not impossible. This led to moves to expand broadband internet connection to every part of the country especially rural areas and low-income neighborhoods. The school system also benefited from this expansion because most students had to switch to online learning during this period. Free internet hotspots (such as libraries, parks, and community centers) were identified and communicated to patients before telehealth visits to ensure they keep to appointments.

The government through the Centers for Medicare & Medicaid Services (CMS) relaxed all restrictive regulations temporarily for telemedicine deployment, including interstate licensing, data confidentiality issues, and most significant reimbursement for these visits. These waivers provided flexibility to healthcare organizations during the pandemic and ensured payment parity between telehealth visits and in-person clinical care.

Pre-COVID19 pandemic, telehealth utilization faced various challenges. The most significant is the limited reimbursement by federal, state, and private insurance outfits. Other challenges include inadequate telemedicine parity laws, high cost or the limited availability of high-speed internet (particularly in rural areas where telehealth is most needed), state licensure laws when telehealth crosses state borders, lack of standards, lack of evaluation by a certifying organization, lack of sophistication on the part of the patient, particularly in the elderly and under-educated and Ethical and legal challenges. Before the pandemic telehealth visits were poorly incentivized. Medicare restricted coverage for telehealth visits to patients in a designated rural area, and patients who travel to a medical facility for telehealth care.

As we get to the end of the pandemic and the waiver period elapses, telehealth services will begin to see a drop in its utilization. Successes made in the adoption of this technology might be reverted if efforts are not made to properly incentives these visits.

Some steps have been taken by the CMS to this end. Once the COVID-19 PHE ends, the Consolidated Appropriations Act of 2022 will ensure a 151-day extension period before the expiration of the waivers and gives room for a transition period.

The increased flexibility regarding where a patient receives care will be reverted to the pre-pandemic policy. Medicare will no longer cover audio-only visits for physical health encounters. Medicare reimbursement for mental health telehealth services will again require an in-person visit within 6 months of the initial assessment and every 12 months following. Medicare reimbursement for telehealth visits furnished by physical therapists, occupational therapists, speech-language pathologists, and audiologists will no longer be allowed. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will no longer be able to be reimbursed as distant site telehealth providers for non-mental health services.

Healthcare organizations need to prepare for this transition and get innovative on ways to ensure utilization of telehealth platforms doesn't drop significantly and recourses channeled to the expansion of telehealth services are not wasted post-pandemic.