On Monday, the second U.S. COVID-19 death was confirmed, with at least 88 others infected. The global death toll continues to rise and has now surpassed 3,000.
Last Tuesday, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, announced that the spread of the coronavirus in the U.S. is no longer a question of when but how widespread it will be. She emphasized that one of the ways health systems can mitigate transmission is by using telehealth to triage and treat low-risk patients. We agree. However, we need help from Congress to ensure that telehealth is a viable option for all seniors; particularly given that the fatality rate for older patients is significantly higher.
Telehealth, which has proven to be a very practical tool in addressing patient needs during flu season, will improve our collective ability to address COVID-19 if it hits on a larger scale. Telehealth offers several advantages over in-person care in the event of a pandemic.
One key advantage of telehealth is speed. Patients can access clinicians 24/7 without an appointment or physical trip to the doctor. Using telehealth, our providers in the Stanford Primary Care team, MedStar Health and Intermountain Healthcare have been actively evaluating and treating patients with influenza. Current providers at Stanford estimate that almost 50% of patients are getting oseltamivir (Tamiflu). Because there is no current, specific medication for the coronavirus, we must be able to advise patients of reasonable self-directed treatment and surveillance to keep them home.
Keeping patients at home is a significant advantage of telehealth. In-home video visits limit community exposure by allowing patients to avoid contact with other patients in waiting rooms and direct contact with providers during the exam. Our health systems have providers who are equipped to work from their own homes, significantly increasing the safety of providers and bolstering the workforce to respond to crisis. Workforce readiness in a crisis—which may include such dramatic measures as school and day-care center closures—is a significant concern for health systems that may be strained to respond. Health systems are also using telehealth to continue surveilling patients already identified as at risk while keeping them at home.
Next, telehealth ensures that treatment in brick-and-mortar settings is reserved for high-need patients. Moreover, with patients being seen in their own homes, providers and health systems will be able to triage and screen exponentially more patients with telehealth vs. an in-person visit—allowing them to steer the most-urgent cases to brick-and-mortar settings.
Finally, telehealth allows patients who do not have access to infectious disease specialists to access this specialized care from the small number of experts across the country. When Intermountain first offered ID telehealth consultation to rural systems throughout the West, one provider fielded 1,000 consultation requests in the first 15 months. To date, the service has provided telehealth care to over 4,700 patients, 50% of whom are older than 65.
Each of these advantages illustrate how telehealth can thwart the spread of COVID-19 and stop it from overwhelming our already stretched medical system.
However, Congress must act to ensure that seniors—a particularly vulnerable population generally and for this virus in particular—are able to receive necessary triage and care through telehealth.
Today, there are restrictions in Medicare that prevent providers outside of very rural areas from being paid for care provided through telehealth. As a result, many providers do not offer telehealth services to seniors. The lack of reimbursement creates a perverse incentive of encouraging patients to come for in-person care, which will only overwhelm our health system as well as augment the virus' spread.
Congress must give the HHS secretary the ability to waive these restrictions in times of public health emergencies. As part of the bipartisan, bicameral Connect for Health Act, telehealth champions in Congress foresaw this need and drafted a provision that would give the secretary the ability to waive telehealth restrictions just as they would waive conditions of participation, Stark law licensure, or other requirements when public health emergencies are declared.
We urge congressional leaders to include this important provision in the upcoming supplemental appropriation to fight COVID-19.
Dr. Todd J. Vento is medical director for the Infectious Diseases Telehealth Service at Intermountain Healthcare; Dr. Ethan Booker is medical director at MedStar Telehealth Innovation Center; and Dr. Lawrence "Rusty" Hofmann is medical director of digital health at Stanford Health. All are members of the Alliance for Connected Care.