#7 Increased Access to Telemedicine through Novel Practice & Policy Changes

Overview

Extending the healthcare environment into the patient’s home has been a goal for decades. The reasons have been obvious – removing the geographic barriers to care can result in timelier, more efficient, and more optimal outcomes – but the movement has been slow. COVID-19 saw increased adoption of telemedical practices as clinicians were forced to conduct their visits online. This practice opened the door to increased consumer adoption and an increasingly virtual care model through shifts in policy.

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.

Through the years, policies have slowly shifted to expand coverage of virtual care, but many geographic areas and services that are safe to provide via telehealth had yet to be explored. 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 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 and community members.

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, and expanding the number of sites qualifying for coverage. 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 2020, a survey of some 1,300 physicians found that 90% were using at least some form of telehealth, and 60% were planning to continue that practice after the emergency. In May 2020, a survey of hospitals and health system executives 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.

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