When physicians’ offices were closed because of the COVID-19 pandemic and patients were under emergency stay-at-home orders, telehealth offered a way to maintain continuity of care.
In that respect, telehealth was just what the doctor ordered, and adoption of the technology skyrocketed because it filled a need by allowing health care services to be delivered while maintaining physical distancing. But this acceleration was also facilitated by the federal government, individual states and private insurance companies listening to physicians and removing regulatory barriers that previously limited telehealth use and payment of services.
AMA experts joined ReachMD host Matt Birnholz, MD, for a “Perspectives with the AMA” podcast in which they offered insight into the events that transpired to create the explosion of telehealth use and what is needed to sustain this forward movement.
Physician telehealth adoption had already doubled between 2016 and 2019 from 14% to 28%, according to AMA digital health research, and is now estimated to be anywhere between 60% to 90%, said Meg Barron, AMA digital health innovations vice president.
Physicians were “loud and clear” about what they needed to know before they felt comfortable adopting telehealth, Barron explained. The questions physicians needed answered were:
- Can you prove to me that it works, and were physicians involved in developing the technology?
- Will I receive proper payment?
- Is there liability coverage and can I feel confident in the efficacy and security of its solutions?
- Will it work in my practice? Can it fit in my workflow and be integrated into my electronic health record?
Sandy Marks, AMA senior assistant director of federal affairs, explained how regulations that were limiting telehealth use were eased.
Prior to the COVID-19 pandemic, Medicare limited telehealth coverage to rural areas and required patients to travel to a clinic or other facility to receive telehealth services.
“So those were the two big changes that Medicare made for the pandemic,” Marks said. “Patients can now receive telehealth services anywhere in the country that they happen to live, and they can receive telehealth services in their homes.”
Other key Medicare changes included making telehealth services available to both new and established patients and making payments for virtual visits the same as for in-person visits.
Widespread adoption of personal communication devices by patients certainly helped spread telehealth adoption. But, in areas where broadband internet access is limited or with patients who don’t use the technology, Medicare expanded coverage and boosted payments for services delivered via audio-only telephones.
Allowing emergency medicine physicians and critical care specialists to provide telehealth services spread adoption further, as did expanding access to virtual Medicare diabetes prevention program (MDPP) services, Marks said.
Almost every state expanded coverage for and access to telehealth services by state-regulated insurers or Medicaid programs, said Kim Horvath, a senior legislative attorney with the AMA State Advocacy Resource Center.
Often, state action mirrored what was being done by Medicare, Horvath said. These actions included:
- Removing “originating site” restrictions.
- Expanding the types of care that could be delivered.
- Eliminating geographic restrictions.
- Ensuring payment parity between virtual and in-person visits.
- Extending coverage to audio-only visits.
A major action taken by some states in regulating commercial plans was to require insurers to allow patients to access the same physicians via telehealth as they had in-person prior to COVID-19. Some plans have a separate network of telehealth providers which may not include all in-network physicians.
While patients enjoy the convenience of a telehealth visit, physicians appreciate being able to see patients in their homes, see what’s in their kitchens and get a more realistic picture of how patients can function, Marks said.
To keep these benefits going forward, she said the AMA is advocating for Medicare to permanently remove geographic restrictions on telehealth and permanently allow patients to be seen in their homes.
Another step in the right direction would be for Medicare to cover DPPs that are done entirely online, Marks said.
On the state level, Horvath said the AMA is advocating to make telehealth coverage parity permanent for state regulated insurers and Medicaid. For state-regulated private plans, she said the AMA is also advocating to ensure that all in-network physicians be allowed to provide telehealth services to their patients.
For physicians looking to implement or refine their telehealth services, Barron recommended they review these AMA resources.
The AMA Telehealth Implementation Playbook includes guidance on identifying needs, forming teams and defining success, as well as designing workflows, partnering with patients and scaling operations. Also check out the AMA’s quick guide to telemedicine in practice.
The AMA’s STEPS Forward™ open-access module “Telemedicine: Providing Safe Care During Coronavirus Pandemic,” which can be taken for 1.0 continuing medical education credit, teaches physicians how to evaluate, diagnose and treat patients via telehealth and about the evolution of telemedicine and the power of using virtual connections, image sharing and video conferencing.
Read about how the AMA’s digital leadership is ensuring that the physician perspective is represented in the design, implementation and evaluation of new health care technologies.