Policy Changes in Response to COVID-19 Support Growing Telehealth Trend

The Coronavirus pandemic has forced people all across the country, and the world, into their homes. Telehealth is having its big moment as those who begin to feel symptoms are encouraged to first contact their doctor before venturing out to seek in person medical attention. 

Prior to the COVID-19 outbreak, telehealth was a state driven service, limited in scope, that mainly serviced veterans and behavioral health communities. Now, the country is experiencing increased access to telemedicine which may change the way healthcare is provided to beneficiaries in the future. While the federal government has implemented temporary coverage for telehealth services, COVID-19 has encouraged states to make larger scale changes that may permanently reduce barriers to telehealth services. It is likely that states will continue investing in and modernizing telehealth services that will mainly impact where healthcare professionals can practice, what services health insurers can cover, and how patient information is stored, maintained, and shared. 

What Does Telehealth Include? 

Telehealth is “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration,” per the Department of Health and Human Services. These technologies include:

• Live video-conferencing: a two-way audiovisual link between a patient and a care provider
• Store-and-forward videoconferencing: transmission of a recorded health history to a health practitioner, usually a specialist.
• Remote patient monitoring (RPM): the use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
• Mobile health (mHealth): health care and public health information provided through mobile devices. The information may include general educational information, targeted texts, and notifications about disease outbreaks. 

There are limited statistics on the usage of telehealth but individuals with upper respiratory infection, and mood disorders or other nonpsychotic mental disorders are most likely to use telehealth. According to FAIR Health’s data set of 29 billion private healthcare claim records, telehealth usage increased 53% from 2016 to 2017. Over 2014-2018, the usage of non hospital telehealth grew 1,393 percent.(1)

The Federal Approach to Telehealth to Reduce the Spread of COVID-19

Though telehealth was in practice prior to coronavirus, it has become a vital part in promoting long-distance clinical health care, patient and professional health-related education, and public health and health administration.(2) Hospital wait times, risk of transmission, and lack of medical resources have forced the government’s hand to allow increased accessibility to telehealth services. On March 17th, 2020, the Trump administration announced expanded Medicare telehealth coverage to enable beneficiaries to receive medical services without having to travel. Medicare will also temporarily pay clinicians to provide these services. Additionally, under the President’s 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) have relaxed certain federal privacy regulations to slow the spread of COVID-19.(3)

Medicare beneficiaries, especially those at higher risk for COVID-19, are able to use telehealth services for common office visits, mental health counseling, and preventative health screenings. Additionally, HHS ensures that Medicare coverage for Medicare telehealth services to beneficiaries will be at the same rate as regular, in-person visits.(4) The agency will not conduct audits to track whether there was a prior patient-physician relationship for claims submitted during the public health emergency and HIPAA enforcement will not impose penalties for noncompliance with regulatory requirements.(5) This change reflects a 2018 regulatory reform at the Veterans Administration. The reform standardizes the delivery of care by VA health care providers by ensuring that providers can offer the same level of care to all beneficiaries, irrespective of location through telehealth.(6)

The federal landscape for telehealth is rapidly changing and opening opportunities for health care companies to adapt to what possibly might become a new standard of care in a post-coronavirus nation. The Trump administration’s announcement of expanded telehealth coverage sets a precedent that may encourage governors and state legislatures to implement similar policies to mandate that health insurers cover COVID-19 testing and treatment at the state level. Since healthcare is an issue that falls under the jurisdiction of states, states have deployed telehealth through different means in order to combat the spread of COVID-19.

States Expanding Telehealth Policies to Manage COVID-19

To perform telehealth at the state level, most states require that the physicians be licensed in the state in which the patient is located. Forty-nine state boards, plus the medical boards of the District of Columbia, Puerto Rico, and the Virgin Islands, mandate this requirement.

Prior to the COVID-19 outbreak, many states already had telehealth systems and standards in place. Eighteen state boards allow physicians to practice telemedicine across state lines by registering with that state or obtaining a special purpose license.(7) License portability, meaning that healthcare professionals may transfer their professional licenses to another state when they move residences, is a topic that has recently garnered attention in the medical field, especially amidst this pandemic, and has contributed to giving both healthcare professionals the freedom to change residence and patients more flexibility in seeking treatment from healthcare providers.(8) Telehealth policies have fluctuated state by state, causing individual states to respond to COVID-19 in different ways.

States have implemented changes to expand overall access to telehealth. This is because state legislators and governors are concerned with whether or not insurers will cover COVID-19 related testing and treatment. For example, Massachusetts Governor Charlie Baker ordered all commercial insurers, self-insured plans, and state health plans to cover all clinically appropriate telehealth services at the same rate as in-person care.(9) California, Florida, and Texas have also expanded their telehealth coverage laws to ensure that doctors and patients are able to connect online and that physicians get paid.(10) On the legislative end, Maryland, Minnesota, Michigan, and New Jersey have introduced legislation requiring health carriers to provide coverage for telemedicine services, especially those related to COVID-19. 

In addition to mandating coverage of COVID-19 testing and treatment, states are introducing and implementing temporary laws that allow health care practitioners to provide services outside of the state in which a patient resides. These policies have allowed out-of-state healthcare professionals to ease the workload of healthcare professionals who are currently in states that have been heavily impacted by COVID-19. For instance, Washington is allowing volunteer doctors to treat patients even if they’re not licensed in the state as long as they can legally practice elsewhere.(11) Vermont, Maryland, and New Jersey have also introduced legislation allowing for out-of-state licensed healthcare professionals to practice telehealth services to patients in response to the coronavirus outbreak. 

Finally, states are also expanding what is covered under telehealth services to ensure that patients have access to healthcare without having to leave their homes during the COVID-19 crisis. Texas, for example, has made large scale changes to telehealth laws allowing providers to use whatever platform they prefer or have available to them, including telephones, to connect with patients. Additionally, the state provides that doctors no longer have to establish in-person care of a patient before they use telehealth services.

The nation is witnessing a transformation of how patients receive and how healthcare professionals provide care to those in need through telehealth. States are developing strategies to address and manage health care in this crisis which will lead to short and long-term impacts on healthcare professionals, patients, and other stakeholders. 

How Are Stakeholders Impacted? 

While the situation continues to unfold, the increase in telehealth coverage in response to COVID-19 has led to positive changes for healthcare professionals, patients, and other stakeholders. 

What’s Next: 

The developments that the Trump Administration and states have implemented will have lasting implications for telehealth beyond the COVID-19 pandemic. 

First, this piecemeal state response makes it clear that there should be comprehensive national standards for telehealth. Healthcare professionals should have the flexibility to practice and see patients across state lines. Patients should be able to receive medical care from the comfort and safety of their own homes, particularly for routine family practice concerns or to limit travel time and expenses associated with routine specialist appointments. 

In addition, the COVID-19 pandemic makes it clear that technology such as patient-doctor communication apps need significant improvement. Consumer technology such as Zoom, Skype and Facetime are being used for remote consultations because they are widely used among consumers. However, these apps do not meet patient data privacy requirements, and a recent news article raised concerns that Zoom has been sending user data to Facebook.(13) 

Overall, even though many of the federal and state policy developments may be temporary in nature, the COVID-19 pandemic is likely changing perceptions about telehealth. Market research demonstrates that millennials are supportive of telehealth due to factors such as convenience in scheduling appointments, and affordability.(14) While issues such as disparate insurance coverage and license portability will need to be resolved, society can anticipate that the demand for telehealth will continue to increase. 

Citations

Note: this information is up-to-date as of April 1st, 2020