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Telemedicine After the Pandemic - What can we Expect?

INTRODUCTION

The COVID-19 Pandemic has caused radical changes in how healthcare is delivered. Telemedicine has emerged as a preferred means of providing patient to physician communications. The migration to telemedicine from in-person patient contact has been facilitated by changes to a variety of federal and state regulations. This article will discuss how these changes have affected telemedicine and what the future might hold for this popular form of patient/physician interaction after the Pandemic is over.




THE SHIFT TO TELEMEDICINE

The movement from in-person to telemedicine for patient to physician contacts during the COVID-19 Pandemic has been truly epic. One large healthcare system reported an increase from 2284 telehealth visits in the 11- week period before COVID-19 to 12,946 telehealth visits during the 11 weeks following the Pandemic. This change represented an increase in telemedicine from 7-18% of all visits prior to the Pandemic compared to 54-72% after the Pandemic.


A 2020 report described a shift to providing high quality, geriatric psychiatric care by telemedicine during the Pandemic. The same authors suggested that this type of care will persist as a primary mode of providing psychiatric care when the Pandemic is over.

In order to stimulate these kinds of migrations to telemedicine during the Pandemic, multiple changes were made to a variety of factors pertinent to the regulation of healthcare. Predicting how these changes will be integrated into a post-Pandemic healthcare system is hazardous but several recent articles have addressed this challenge.

CHANGES IN PAYMENT?

Reimbursement for telemedicine visits is a key determinant of how willing physicians are to adopting this mode of patient interaction as a significant proportion of their practices post-COVID. Prior to the Pandemic, some states required insurers to reimburse physicians for telemedicine visits but did not specify payment parity with in-person visits. During the Pandemic many healthcare systems including Medicare have adopted equal payment for telemedicine visits as for in-person visits. Some have questioned that maintaining equal payments after the Pandemic could be “perversely incentivizing” telemedicine. So-called payment equity or payment parity has been recommended to provide adequate but not excessive relative reimbursement for telemedicine as compared to in-person visits.



CHANGES TO PATIENT ACCESS

Prior to the Pandemic, most patient/physician interactions occurred in-person after patients made an appointment. With the advent of Smartphone Apps such as the Illuminate Health App for iOS or Android, physicians can be available either for immediate telemedicine contacts or for future scheduled appointments.

It is estimated that over 80% of people in the US possess a Smartphone and many people now use their Smartphones for online access and no longer maintain broadband internet access. Unfortunately, minorities and people with low socioeconomic status who are most in need of access to physicians, are most frequently those who do not own a Smartphone. Notably, mobile-first populations, those who rely solely on their device for internet access, are largely from racial/ethnic minorities, which presents opportunities for patients who also tend to have worse health outcomes. A 2019 report suggested that “smartphones will become the milestone of future cardiology…”



CHANGES TO STATE LICENSING REQUIREMENTS

A 2018 article suggested that low reimbursement rates and lack of interstate licensing were the two primary limitation to widespread acceptance of telemedicine. In response to the Pandemic, several states joined together in agreements to allow physicians to practice telemedicine across their state lines. Physicians can use the Illuminate App for telemedicine and practice across state lines when necessary. It is unclear if this relaxation in state licensing laws will continue after the Pandemic.




PATIENT ACCESS TO THEIR HEALTHCARE RECORDS

In March 2020, the Department of Health and Human Services passed the 21st Century Cures Act that aims to provide patients increased access to their health data. Specifically, electronic health companies are mandated to maintain data security while removing barriers that previously limited the ability of smartphone applications to be used to access patient data. With the Illuminate Health App, patients have full, password protected access to their healthcare information at any time. Physicians can decide if they wish to keep a separate record of their telemedicine visits conducted with the Illuminate App. If they do, they will have to make such records available to reasonable patient requests to review them.



TELEMEDICINE AND HIPPA

The Department of Health and Human Services (DHHS) has relaxed guidelines on using certain platforms for telemedicine during the COVID-19 pandemic. HIPPA violations are relaxed as long as the visit is in “good faith” when telemedicine is used for any treatment or diagnostic purpose. In addition, software supporting video platforms including Skype, Zoom, Google Hangouts and Apple FaceTime are allowed for use, but those with social media capabilities (Facebook Live, Twitch) are still not allowed to be used.

After the Pandemic, it seems questionable if the HIPPA rules will continue to be relaxed for certain platforms. Physicians who use the Illuminate platform for telemedicine will not need to worry about HIPPA regulations since that platform is fully HIPPA compliant.



CONCLUSIONS

The COVID-19 Pandemic has caused an explosion in telemedicine, facilitated by changes to a variety of state and federal regulations. It is unclear at this time, how many of these changes will continue when the Pandemic is over. Many physician concerns about the future of telemedicine after the Pandemic can be allayed by the use of the excellent Illuminate Health App.


Robert Young, M.D.

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