Telehealth Expansion Minimizes Infection, Frees Clinic Space

The SARS-CoV-2 virus outbreak has forced the population at large apart, confining people to their homes, some unable to see families and friends amid the crisis. Thankfully modern telecommunication (telecom) technology—computers, tablets, smartphones, maybe even your refrigerator—enable video conferencing around the globe, requiring only an internet connection. It’s a welcome reprieve from the loneliness-inducing (though still practical) social distancing to see a loved one’s face, even if it is digital.

Modern telecom technologies are commodities but their ubiquity has made them essential tools for success in the modern world, even more so during the COVID-19 outbreak. As the virus threatens to overburden the healthcare system, remote healthcare delivery via telecom technologies (telehealth, or telemedicine) helps “flatten the curve” of new infections during this and future outbreaks.

Recognizing this opportunity, on March 13 the Trump administration made an emergency declaration that granted expanded Medicare telehealth benefits under Centers for Medicare & Medicaid Services’ (CMS) 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers will be temporarily paid at the cost of in-person services to provide telehealth services for beneficiaries across the U.S. in any healthcare facility including a physician’s office, hospital, nursing home, or rural health clinic, as well as from their homes.

“These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus,” CMS administrator Seema Verma told the press. “Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

Before this, Medicare could only pay clinicians for telehealth services like routine visits for patients in a rural area. Patients still had to travel to a local clinic to speak with their doctor because generally, home telehealth services weren’t covered. Now Medicare can cover remote common office visits, mental health counseling, and preventive health screenings. Medicare beneficiaries, typically a higher risk for COVID-19, won’t have to unnecessarily enter a healthcare facility thanks to broadened telehealth flexibility.

Emergency departments and doctor’s offices are also freed up to handle the most urgent cases. For example, a diabetes patient—a common clinic visitor—could video chat with his or her doctor to discuss management or refill a prescription, making the office more available to treat those who need to be seen in person and mitigating the virus’ spread.

States including Massachusetts and Florida have also begun to expand telehealth coverage, and Washington is aiming to let doctors volunteer to remotely treat patients even if not licensed in the state, provided they can legally practice elsewhere. Over 260 doctors have already volunteered, Stephanie Mason of the Washington State Medical Commission told CNBC.

The demand for remote health services will continue for the foreseeable future. But confusion about state-by-state regulations and little clarity about what is allowed challenges telehealth providers. Private health plans also aren’t reimbursing doctors at the federal government’s pace.

For example, San Francisco-based telehealth firm PlushCare, which helps patients access birth control among other drugs through an online network of doctors, now assists patients with COVID-19 symptoms who aren’t critically ill and can be remotely monitored. The company’s doctors, which can treat patients in states where they’re not currently licensed, reached out to state medical commissions. Response has been varied—employees are working from home and states still haven’t figured out their telemedicine policies.

“Oregon just rejected us because we didn’t have a facility there, and they told us to get one before we reapplied,” PlushCare co-founder and Chief Medical Officer Dr. James Wantuck told CNBC. “North Carolina, we found out, is really targeting retired doctors who previously had a license in that state, while other states like Mississippi, Colorado, and Florida are making it very easy for our doctors to get licensed there.”

Medical providers must do their own research to determine what’s allowed, and the answer isn’t always clear. And while the federal government is increasingly paying for telehealth, a commercial health plan might not.

Despite this, the telehealth market persists. Shares of phone and video health services provider Teladoc remained flat despite the S&P 500’s 25 percent plunge from Feb 20 to March 18.  There’s an opportunity for telehealth firms to grow in this environment while making a meaningful impact on this and future public health crises. But they have to decide the best route for expansion given the rules are still being drafted.

“My advice is, yes do it, because you could go out of business in the next few months if you don’t,” Farzad Mostashari, CEO of Aledade, a startup that helps health practices adopt new technology and shift their payment models, told CNBC.

On March 20, the U.S. Food and Drug Administration (FDA) further boosted access to telehealth by issuing a policy allowing remote use of certain FDA-cleared devices that noninvasively measure body temperature, breathing rate, heart rate, and blood pressure for the duration of the COVID-19 outbreak.

“During this public health emergency, it is imperative that the FDA provide regulatory relief and adapt as the situation warrants to act upon measures to save lives,” FDA Principal Deputy Commissioner Amy Abernethy, M.D., Ph.D., told the press.