Historically, minimal effort has been made to steer the bulk of the population toward care through virtual means, but innovative care providers and open-minded patients have been benefitting from the flexibility and versatility of telehealth for years. In response to the COVID-19 pandemic, telehealth became the buzzword of 2020, and as all sides – insurers, clinicians, and individuals – grow more comfortable with it as a convenient, quality, low-cost source of healthcare, we are seeing aggressive incentivization of the use of virtual options. Layering in burgeoning adjacent applications like remote monitoring, the use cases for telehealth in our society continue to grow. The shift away from brick and mortar visits has been swifter than anticipated, demanding more adaptability than the healthcare ecosystem has ever shown. But as health systems and hospitals adjust their workflows for COVID-19, they’re learning some valuable lessons on how to best use connected health technology for streamlined models and improved outcomes. Telehealth and remote monitoring initiatives have revolutionized a centuries-old care model in a matter of months, but the nearly seamless transition to virtual care has established a preference for telehealth for many patients and clinicians alike. There are, however, some questions that remain about this mobile health strategy and requirements for its long-term success.
The Health Resources & Services Administration (HRSA) of the Department of Health & Human Services (HHS) defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Today’s telehealth delivery platforms fall into two main categories: provider-to-provider and direct-to-consumer. Provider-to-provider extends expertise and resources for specialty and subspecialty care, and addresses workforce shortages and the efficient use of health professionals, while the direct-to-consumer category includes virtual care, remote patient monitoring, and extending care delivery into the homes of patients via technology. Both categories of telehealth delivery are enhancing the ability to care for more individuals across the country for an array of services and disease states.
Even before COVID-19, hospitals’ use of telehealth has skyrocketed in recent years. While some slower to adapt than others, digital care models have been undoubtedly changing for the better. According to the American Hospital Association (AHA), hospitals are most likely to use telehealth is to extend access to specialty care, conduct efficient post-operation follow-up, and lower hospital-readmission rates through better medication adherence and positive care outcomes. By increasing access points and redistributing expertise where it’s needed, telehealth can address disparities and improve health outcomes from pediatric health services to senior care. As of 2019, the following specific services were cited as the most popular uses of telehealth by provider organizations: pharmacy services such as medication review, patient counseling, and prescription verification, chronic care management through the equipment of patients with home-monitoring systems for transmission of vital signs, telestroke services used to increase access to the limited supply of stroke neurologists, tele-ICU tools for 24-hour intensivist support of intensive care unit staff, specialty telemedicine consults to address challenges patients face regarding access, diagnostic screenings when applicable, the monitoring of sleep disorders like apnea and insomnia, telepsychiatry serves for those in need of behavioral health assessments, and long-term guidance for those with an opioid use disorder. Of course, most recently, hospitals are using telemedicine to address a host of concerns affiliated with COVID-19 – providing high-quality care, keeping up-to-date on emerging information, and reducing other patients’ and providers’ exposure to the virus.
Through the years, consumers too have increasingly leveraged their use of offered telemedicine services – citing its ease and accessibility in the triage of medical problems. A 2018 FAIR Health study found the top-3 conditions consumers had addressed by telehealth were injuries (ex. contusions and open wounds), acute respiratory infections, and digestive system issues. Other common conditions included fever, headache and general malaise, mental health, and joint concerns. Amid COVID-19, consumers even further leveraged their ability to complete visits virtually. Both those exhibiting symptoms of the virus and those simply needing to complete routine visits turned to telemedicine as the methods were further encouraged by their healthcare providers.
By increasing access to physicians and specialists, telehealth helps to ensure that patients receive the right care at the right place and at the right time. Telehealth expands access to services that otherwise may not be sustained locally. However, there are several barriers to expanding access to care through the use of telehealth, including risks like the uncertain and dynamic regulatory environment, exposure to potential medical malpractice, data breaches, licensure issues, and statutory restrictions on how Medicare covers and pays for telehealth. In the Calendar Year 2019 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare & Medicaid Services (CMS) expanded Medicare coverage for virtual services, and the agency provided waivers in some alternative-payment models, but the change was nowhere near fundamental enough expand payment to all geographic areas and all services that are safe to provide via telehealth. But in response to COVID-19, on March 6, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act – a legislation to allow physicians and other healthcare professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency. Since then, state and federal regulators have moved quickly to reduce telehealth adoption barriers, understanding that these new tools could speed access to care while protecting healthcare workers.
The CMS launched several emergency initiatives that expanded Medicare and Medicaid coverage, including increasing the types of providers able to use telehealth, allowing providers more freedom to use different modalities – such as remote patient monitoring and phone-based services – and expanding the number of sites qualifying for coverage to include homes, federally qualified health centers, and rural clinics.
State regulators added their own emergency directives, expanding Medicaid coverage, enabling more care providers to use telehealth, requiring private payers to cover telehealth services and, in some cases, tweaking the rules to allow out-of-state providers to use telehealth to treat residents, and providers in the state to treat residents of other states. Other federal agencies took action as well. The HHS dished out a number of grants and awards, while the Federal Communications Commission (FCC) launched its own $100 million COVID-19 Telehealth Program, aiming to support broadband expansion projects that pushed new telehealth services into rural areas where connectivity is lacking.
These measures opened the floodgates for telehealth, allowing for new programs and the expansion of existing networks. In April, a survey of some 1,300 physicians by the online physician network, Sermo, found that 90% were using at least some form of telehealth and 60% were planning to continue that practice after the emergency. In May, a survey of hospitals and health system executives by Xtelligent Healthcare Media put that number at 63%, well above the 20% adoption rates seen prior to the pandemic. At Cleveland Clinic, use of virtual visits rose across specialties, transforming the model of delivery nearly overnight.
Technically, there is a ceiling for the utilization of telehealth. Not everything can be addressed over video, and long-term regulation remains fuzzy, but there are still immense growth opportunities as use-cases continue expanding and adoption ramps. With the fire lit by COVID-19, the health ecosystem has been primed for success by way of expedited outcomes, improved patient/provider experience, and increased access to care. Awareness of, and comfort with, the technology is reaching a tipping point, and the breadth of usage is expanding rapidly. Those working in the field view this point in time with admiration and excitement as telehealth’s growth in following fuels the nation for sustained widespread adoption. We look forward to tracking the progress made in the space over the next several months and sharpening our predictions for its future – through and beyond this unprecedented time.
For future of healthcare and healthcare innovation conversations with a focus on topics like telehealth and other revolutionary technologies, tune into Cleveland Clinic’s Medical Innovation Summit, Transformation Tuesdays webinar series, and forthcoming Health Amplified podcast.