For years, telemedicine advocates have pushed to make it easier for patients to access care remotely. Many, but not all, of the barriers they had been fighting fell last month as lawmakers and government officials rushed to make telemedicine more available in the wake of the novel coronavirus.
Telemedicine has been cited as a promising avenue to reduce the spread of COVID-19, letting patients receive care at home without visiting a crowded emergency department, and minimizing the need for providers to use personal protective equipment that is in short supply.
Federal agencies are "really trying to bend over backwards to get the regulations out of the way," so providers can continue their work on the front-lines, said Thomas Ferrante, a senior counsel with law firm Foley & Lardner's telemedicine and digital health industry team.
The CMS said this week that it would temporarily reimburse providers that treat Medicare beneficiaries remotely for more than 80 emergency, pediatric critical care and other services at the same rate as in-person visits. The Federal Communications Commission also released a plan for a $200 million telemedicine program targeting COVID-19.
The government waived other restrictions in recent weeks, such as allowing Medicare beneficiaries to access telemedicine from almost anywhere including their homes during the COVID-19 public health emergency. Traditionally, Medicare has limited telemedicine services to beneficiaries located in rural areas and only been accessible when they're at a qualified healthcare organization.
"I think that really opened up the floodgates," said David Gray, senior manager for congressional affairs at the Healthcare Information and Management Systems Society.
Many healthcare organizations are feeling as if "basically every barrier that they've had came down" in the span of just a few weeks, said Krista Drobac, executive director at the Alliance for Connected Care.
Regulatory restrictions had posed major challenges to telemedicine expansion. Lack of reimbursement ranked the most commonly cited reason healthcare organizations said it was challenging to implement telemedicine, according to a survey that Foley & Lardner released in 2017.
Providing the same level of reimbursement for remote and in-person visits could play a significant role in helping healthcare organizations maintain some of their dented revenues during the pandemic, said Travis Broome, vice president for policy at Aledade, which partners with primary-care physician practices to form accountable care organizations.
Licensing barriers are the main speedbump for telemedicine adoption now, according to experts.While some states have waived state licensing restrictions in response to COVID-19, not all have.
"There isn't really a mechanism to do it in a uniform manner by the federal government," Ferrante said.
But for some healthcare providers, particularly those in rural areas, the challenge to standing up telemedicine programs goes beyond policy and payment—it's a question of whether providers and patients have strong enough internet access to enable video visits.
"You can't have telehealth, you can't have remote patient monitoring, without broadband access," Gray said.
Congress addressed that challenge by directing $200 million to the FCC as part of the Coronavirus Aid, Relief, and Economic Security Act. FCC Chairman Ajit Pai on Monday said the agency would use those funds to help eligible providers buy telecommunications, broadband connectivity and devices needed to provide telemedicine services during the COVID-19 emergency.
Drobac said she expects to see additional funds allocated toward building up broadband infrastructure in future funding package related to COVID-19.
But FCC's approach still sparked some concern, particularly over the agency's definition of eligible providers. It includes a broad range of organizations such as not-for-profit hospitals, medical schools, local health departments and skilled nursing facilities—however, it excludes for-profit hospitals.
"I was shocked that the FCC came out with funding for broadband and explicitly excluded for-profit hospitals," said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents investor-owned and managed hospitals. Many of the FAH's members serve rural areas, which tend to be most in need of strengthened access to telemedicine.
FCC has focused funding away from for-profit providers previously. The FAH, the American Hospital Association and the American Academy of Family Physicians last year pushed back on a provision included in the FCC's proposed Connected Care Pilot program, which had also excluded for-profit hospitals.
Kahn expressed support for the CMS' recent regulatory changes, noting regulatory and financial relief for telemedicine are "particularly important in this period of necessary isolation."
While the CMS' regulatory changes are designed to lapse when the public health emergency ends, it will be difficult to transition away from telemedicine overnight, particularly if patients have been using it regularly.
With hospitals and clinics investing time, resources and money into building out their telemedicine services, they'll likely want to continue to capitalize on them after the pandemic lapses. Patients who enjoy using telemedicine might also be confused when the option is taken away.
"Every day, thousands of people are doing their first telehealth visit," Broome said. "We will all, as a country, be more comfortable with the idea of telehealth and telemedicine on the other side of this."
