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COVID-19 may permanently alter the telehealth landscape, from reimbursement to utilization

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Lasting change will have to come from Congress, but there will be more of an impetus now that telehealth is getting its day in the sun.

The COVID-19 coronavirus pandemic has changed the way people interact with each other, with scores flocking to video services to get their social fix. This embrace of remote-video technology has extended to clinical interactions with the healthcare system as well, and this has brought about some changes that may be permanent, from the way healthcare is utilized to the reimbursement policies enacted and enforced by the federal government.

Even providers who previously didn’t offer telehealth services are scrambling to implement the technology in some form, both as a way to maintain patient-care standards and as a means of making up for revenue lost through avenues such as elective surgeries, which are being put on hold as the pandemic plays out.

Telehealth is exploding in popularity as a result. While the mode of care delivery has never had an equal footing with in-person clinical encounters in terms of the way it’s reimbursed, patient demand may spur regulatory action to change that.

Dr. Gregg Miller of Swedish Emonds, Seattle, and Chief Medical Officer at Vituity, is among those who are preparing care teams to handle patient encounters remotely. Currently, he’s engaged in planning efforts to train and prepare clinical teams for this new reality at roughly 300 health facilities in the Pacific Northwest.

To prepare staff, Miller and his team have been focused on implementing two levels of education. The first is centered on getting clinicians to step into roles they might not have otherwise assumed, such as telehealth treatment. The second level of education is geared toward healthcare leaders and ensuring they have the right systems in place to implement telehealth in an impactful way.

“They need to make sure they have the infrastructure to capture patient information, register them for a visit and help patients navigate to that platform,” said Miller. “There’s been really good adoption of clinicians on the outpatient side of telemedicine. Where it’s lagging is more on the acute care side. Doctors and providers have realized, ‘I’m not seeing any patients, and the only way I can see patients is through telemedicine.'”

In addition to being able to capture more revenue, these efforts at telehealth adoption show promise for protecting the health of both patients and caregivers. Telehealth prevents clinicians from being infected by COVID-positive patients. But since clinicians run the risk of becoming virus carriers themselves due to the frontline nature of their jobs, it also protects patients from potentially contracting the coronavirus as a hospital-acquired infection. That’s a very real risk in a complex and chaotic healthcare environment.

Implementation of telehealth has differed from health system to health system, depending on their existing infrastructure and capabilities. In some cases, remote care can barely be called true telehealth: Patients use telephones to interact with clinicians during discharge or while waiting for test results. What once was a face-to-face interaction now takes the form of a doctor calling a patient on their phone while the latter is sitting physically in the hospital, awaiting the next steps of their care journey.

“The more complex version is that providers have set up these tents,” said Miller. “In the tent there’s an iPad that’s always on, with an audio-visual connection to a computer that’s in the hospital. They’ve been registered over the phone, and they do have a face-to-face encounter with a triage nurse. … They get placed into an isolation room in the tent, and speak with the physician inside the emergency department through this audio-visual program.”

It’s a creative, quasi-improvisational approach to implementing telehealth services in some form. In Miller’s experience, there have also been inventive ways of using remote technology to follow up with patients after a visit — which technically falls under the umbrella of remote patient-monitoring, a distinct practice from core telehealth services but a close cousin regardless.

Using RPM technologies, patients have been discharged with thermometers and devices that attach to their fingers, which relay vital, real-time health information to providers, including heart rate and blood pressure. Patients can download a hospital’s preferred technology platform onto their smartphones, and with health information flowing freely, they can then receive regular telehealth calls with their providers.

The exact nature of these telehealth encounters are different depending on a specific hospital’s capabilities. The Centers for Medicare and Medicaid Services has waived telehealth-reimbursement restrictions in part to encourage the use of these services. These waivers are temporary, but with telehealth gaining in both popularity and legitimacy, could these changes eventually become baked into the system?

History may point the way to an answer.

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