Hospitals and health systems across the country are seeing huge increases in virtual medical visits, and it's expected that this trend will only continue in a post-pandemic world.
Michigan Medicine went from 400 virtual visits a month to over 9,000 so far in April, according to Andrew Rosenberg, M.D., Michigan Medicine's chief information officer, speaking this week during a meeting of the Health IT Advisory Committee (HITAC).
HITAC advises Congress and the U.S. Department of Health and Human Services (HHS) on health IT policy.
Other health systems have seen similar trends. As recently as March 6, just 6% of primary care visits at UC San Diego Health were virtual, and now it's more than half. In New York City, NYU Langone Medical Center went from 20 to 1,300 virtual care clinicians in just a few days and has seen up to 6,500 virtual visits daily. More than 70% of the organization’s visits are now virtual.
The Trump administration has relaxed some restrictions around telehealth reimbursement amid the COVID-19 pandemic. The waivers by HHS enable telehealth services to be provided in all settings, including a patient's home.
The HHS Office for Civil Rights (OCR) also announced it will waive potential penalties for HIPAA violations against healthcare providers that serve patients through widely available communication apps such as FaceTime or Skype.
Those temporary changes have helped to reduce some of the barriers to telehealth adoption and enabled providers to quickly ramp up technology to provide services to patients at home and curb the spread of COVID-19, healthcare leaders said during the meeting.
The question now is how to sustain those services once the emergency is over.
"Telehealth is something that is here to stay with us and I think will fundamentally change the world on a go-forward basis to what we have today," said Peter Johnson, interim CIO at Beth Israel-Lahey Health.
Health system leaders see virtual care playing a pivotal role in preventing a resurgence of the virus as physical distancing measures become a way of life, according to Dick Flanigan, senior vice president at health IT company Cerner.
"What we're hearing from clients is there's no return to work where everybody just shows back up at the clinics. We don't have universal testing and we're not even sure if the serological testing for antibodies is going to be accurate enough. Telemedicine is not only here to stay it's going to be an absolute requirement to reopen health care in a way that begins to approach normal," Flanigan said.
While there will be a need for on-site medical visits, telehealth and remote monitoring will need to become part of the "new normal."
"We can't have waiting rooms filled with people anymore, whether they be office waiting rooms or emergency departments. Think of all the new ways we're going to have to incorporate technology," he said.
There are steps that the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) can take to further incentivize telehealth adoption and support deployment, healthcare executives said during the HITAC meeting.
"Patients still need healthcare. The only way for the system to stay open for many right now is through telehealth. HITAC should work with ONC and CMS to further incentivize and promote the adoption of telehealth services," said Greg Carey, director of government affairs at health IT company Athenahealth.
Here's what healthcare executives are calling for CMS and ONC to do:
Continue to support reimbursement of telehealth during and beyond the pandemic:
Carey urged CMS to consider reimbursing telehealth services at greater than 100% of the facility rate.
"In addition to funding from the FCC for new technology adoption, this will actually help support that initial investment physicians need to make to adopt and deploy the technology necessary," he said.
Federal Communications Commission (FCC) Chairman Ajit Pai recently announced he wants to use $200 million from the economic stimulus package to expand telehealth services across the country.
If adopted by the commission, the COVID-19 Telehealth Program would offer qualified healthcare providers full funding to buy “telecommunications services, information services and devices necessary to enable the provision of telehealth services during this emergency period.”
On the issue of reimbursement, National Coordinator for Health IT Donald Rucker, M.D., said CMS would likely refine the changes to telehealth regulations.
"I agree that our new normal is different than our old normal," he said.
Develop consistent telehealth standards and associated E/M coding:
Providers are using different virtual care tools and capabilities and that results in significant variability, and many of these technologies don't integrate with electronic health records.
"We're learning we need consistent standards, so during a national health emergency, our clinicians need relaxed guidelines on what is essential to document for billing and coding purposes, and we encourage the continued use to help decrease that administrative burden and documentation requirements for our clinicians," Jackie Gerhart, M.D., physician, clinical informatics at Epic.
She added, "CMS and ONC should really try to encourage telemedicine to be approachable and doable, not only from a technical perspective but also from a reimbursement perspective. I think you'd be surprised at how many people that are in different areas like rural health or underserved communities would be able to get some amazing health care that they may otherwise not be able to."
Work as a convener to gather health IT experts and share best practices:
Providers also face the challenge of implementing telehealth more broadly across all medical specialties. While some specialties lend well to telehealth and remote monitoring, such as primary care and even critical care, others like radiology and ophthalmology are more difficult to implement, Rosenberg said.
"Some specialties require a lot of special devices and techniques to get the images. The opportunities for telehealth are very heterogeneous," he said.
There's an opportunity for ONC to advance the use of technical standards for consumer medical devices that can integrate with telehealth apps, both electronic health record-based and standalone. That would help support the use of telehealth for a broader range of conditions, healthcare executives said.