By early April 2020, though, telehealth saw a spike in use like never before because of the coronavirus pandemic. And even among people who had not yet used telemedicine, having access to it became increasingly important, according to a survey conducted by Everyday Health and Klick Health and completed by 2,398 randomly selected U.S. residents ages 18 or older. The survey, conducted between April 24 and May 5, 2020, found that while only 28 percent of respondents had had personal experience with telemedicine before the start of the COVID-19 pandemic, 48 percent said having a healthcare provider who offered telemedicine services had become more important to them once the pandemic was under way. Among survey respondents who had used telemedicine before the pandemic, 45 percent had used it for renewing prescriptions, 42 percent for getting regular checkups, 27 percent for looking into new conditions or symptoms, and 25 percent for discussing lab test results with their physicians. Sixty percent of all respondents anticipated their use of telemedicine would increase over time. In response to the unprecedented interest in, and need for, telemedicine access, the U.S. Department of Health and Human Services (HHS) temporarily eased or suspended a number of regulations related to telehealth. These regulation changes cover everything from relaxing rules on prescribing controlled substances to allowing doctors to use consumer-oriented video chat services for telehealth appointments. While virtual doctor “visits” aren’t appropriate for all health concerns, they can be useful in a number of situations, such as addressing relatively minor symptoms, managing chronic conditions or certain medications, or talking with a therapist about mental or behavioral health concerns. Here’s an overview of some of the major rule changes covering telehealth in recent weeks, and how they may make it easier for you to get the care you need. RELATED: As Physician Office Visits Plunge, Telemedicine Offers a Safe Alternative “That has been a long-standing barrier for those of us in the telehealth industry,” says Dr. Antall. “It basically said, ‘We’re not going to reimburse for visits unless they occur at a clinical site and in a rural region of the country.’” Now, he notes, hospitals and other healthcare providers can treat patients with different types of health plans — commercial insurance, Medicaid, traditional Medicare, and Medicare Advantage — more equally when it comes to telehealth. This is especially important, says Antall, since many older people in urban areas that are especially hard-hit by the current pandemic weren’t eligible before to see their doctor virtually under Medicare. “That notion of care without exposing yourself to a waiting room, I think, has been really appealing to patients.”
States Give Licensing Reciprocity to Out-of-State Providers
Many states — through governors and state health agencies — have recently waived requirements that a telehealth provider be licensed in the state where a patient is physically located, or granted out-of-state providers emergency licenses. These rules previously limited how many doctors could see patients across state lines through nationwide platforms like Amwell, Doctor on Demand, or Teladoc. As an example of how this change has been beneficial, “New York enacting reciprocity for this emergency allowed us to bring our entire urgent care practice to help provide care” to the New York City region, where it has been most needed during the pandemic, says Antall. Antall notes that telehealth use among Amwell’s more than 240 health system and hospital clients is currently up by about 2,000 percent over normal expectations. In some areas of the country, though, the platform has seen a spike of as much as 10,000 percent. Naturally, it’s very difficult for overburdened local healthcare providers to keep up with this need. For David R. Stukus, MD, an associate professor of pediatrics in the division of allergy and immunology at Nationwide Children’s Hospital in Columbus, Ohio, the loosening of restrictions on out-of-state telehealth visits has not only helped ensure that appointments with existing long-distance patients go smoothly, but it has led to an influx of new patients who might not have previously come for an in-person visit. For people who live in rural areas, without easy access to specialists, improved access to telemedicine is “a huge benefit,” says Dr. Stukus. “They don’t have to drive two and a half hours to come see me.” Stukus’s practice switched from seeing all patients in person to using only telemedicine over the course of about a week this past March.
Free Care Allowed Under Medicare
Under the usual regulations, healthcare providers aren’t allowed to give free healthcare to people enrolled in Medicare plans. That’s because it’s seen as inducement, or unfairly recruiting patients with the goal of getting their business in the future — which would put some providers at a disadvantage to others. But now, enforcement of this rule has been suspended, so healthcare providers can give free care to patients if they want to. “They essentially said, ‘We won’t prosecute anyone for inducement in this situation,’” meaning the current pandemic, says Antall. In many cases, offering free healthcare through telehealth can allow a provider to skip billing procedures and screen people for coronavirus-related symptoms more efficiently. The offer of free care may also make some people more likely to schedule a virtual visit when they have symptoms, says Antall.
Commercial Plans Are Encouraged to Waive Copays
While HHS can’t directly reduce or remove copayments under commercial health insurance plans, the agency can make recommendations in this area that insurance companies are likely to follow. And many health plans have indeed recently waived copays for telehealth visits at the urging of HHS. Stukus notes that along with changes in some copays, there have been changes in how both commercial insurance plans and Ohio’s Medicaid program reimburse providers for telehealth visits — all out of a recognition that this type of visit is the new normal in many areas of medicine. “Waiving patient cost shares was useful, one more incentive to drive patient utilization,” says Antall. “But I’ll be honest: We really didn’t need that incentive during this time. Patients really recognize the value of telehealth while maintaining social distancing, which has driven immense utilization.” According to Antall, a lot of the recent spike in telehealth has been from visits that aren’t directly related to the coronavirus. Instead, many have been related to chronic conditions like diabetes, hypertension, or asthma — and often these telehealth appointments have been at the urging of healthcare providers who want to limit in-person visits. “There has been a bit of a challenge with primary care access. Some providers are semi-closed, some are only seeing nonrespiratory patients, and some are doing most of their care by video or phone,” Antall notes.
Rules on Prescribing Controlled Substances Relaxed
Before the current crisis, telehealth providers were required to have had an in-person visit with a patient within the previous year before prescribing certain medications, such as Suboxone for opioid substance use, stimulant drugs for ADHD, or drugs like Xanax for anxiety. That requirement is now waived, so these drugs can be prescribed by a telehealth provider who has not previously seen a patient in person. This rule change may be especially helpful in light of the recent rise in telehealth visits for mental health problems, says Antall. This rise comes not just from people immediately affected by the coronavirus, but also those who have experienced its economic and social tolls most severely. “We’re seeing a lot of anxiety, family discord, depression, and exacerbation of existing behavioral and mental health disorders,” Antall notes.
Less-Secure Communication Services Are Allowed
Normally, telehealth providers are required to use a communication service or device that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These rules were meant to ensure that all audio and video communications are completely secure and confidential to protect a patient’s privacy. But in the current emergency, says Antall, HHS recognized that many healthcare providers needed to move quickly to telehealth before they could set up a HIPAA-compliant system. Waiving this requirement means that providers can use communication services meant for consumers, like Skype, Zoom, Google Hangouts, Apple FaceTime, or Facebook Messenger. “I have colleagues who work in brick-and-mortar settings, and they’ve really been challenged” by having staff members with health conditions that put them at high risk for severe disease due to the coronavirus, says Antall. “That HIPAA waiver made it easy for them to dig in” and use telehealth widely — even though they know, Antall says, that they’ll eventually need to switch to a HIPAA-compliant communication platform. Stukus’s practice already had plans for telemedicine in motion, so they were able to implement a HIPAA-compliant platform rapidly when the need arose. He notes that by using a platform designed specifically for telehealth, not only are visits secure, but they can also be more seamlessly integrated with existing electronic medical records. In the long run, Antall believes, many healthcare providers will continue to make telehealth “a normal part of what they do” — not just because of the benefits it offers them, but also because of demand from patients. “More often than not, patients will say to me when I do a visit that it’s incredible to do this from the comfort of their own home,” says Antall. “Then they don’t need to hear any more marketing messages. They usually want this kind of care in the future when it’s appropriate.” For Stukus, the current necessity of telehealth has shown just how much can be accomplished without seeing a patient in person. “We’ve gotten creative when it comes to vital signs and physical exams,” he says, with patients able to take certain measurements at home, and both video and photos used to assess visible symptoms and problems. While some in-office testing isn’t possible, “I can still order tests, and they can go to the local lab or hospital to have their blood drawn if they need to,” Stukus notes. While telehealth isn’t right for every visit, “I think it would be a tragedy if we went back to exactly how things were two months ago,” says Stukus. “My patients love it. They ask me, ‘Can we meet like this all the time?’”
