{"id":27016,"date":"2020-04-13T14:34:50","date_gmt":"2020-04-13T14:34:50","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=27016"},"modified":"2020-04-13T14:34:50","modified_gmt":"2020-04-13T14:34:50","slug":"telehealths-not-getting-switched-off-after-covid-19-crisis","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/telehealths-not-getting-switched-off-after-covid-19-crisis\/","title":{"rendered":"Telehealth’s Not Getting Switched Off After COVID-19 Crisis"},"content":{"rendered":"\n

Law360 (April 10, 2020, 7:54 PM EDT) — The coronavirus pandemic has forced the federal government to lift barriers to telemedicine so patients can get care without leaving home. Those regulatory changes may be temporary, but experts say telehealth is here to stay.<\/p>\n\n\n\n

As the novel coronavirus continues its deadly march across the country, patients have been able to monitor their health without setting foot in a medical office or hospital through an unprecedented regulatory revamp of telehealth at the federal and state levels.<\/p>\n\n\n\n

In normal times, Medicare only pays clinicians for telehealth services like routine visits, requires patients to travel to designated sites to obtain virtual care andimposes limits on what communication devices can be used, but the stroke of the president\u2019s pen tossed all of those obstacles aside and provided a glimpse into what the future of telehealth could look like.<\/p>\n\n\n\n

\u201cIf telehealth can do so much during these times, then obviously it can do a lot more on the day-to-day delivery of health care when we\u2019re not under a public health emergency,\u201d Polsinelli PC<\/a> shareholder Kyle Vasquez told Law360. \u201cUnfortunately, we had to go through this wide-scale pandemic to get the attention of payers and state agencies. But I think there will be long-term changes to telehealth, as it has shown how it can add value during difficult times.\u201d<\/p>\n\n\n\n

Federal regulators and lawmakers have for years resisted pressure to expand coverage for telehealth services, voicing concerns about potentially enormous new costs and the quality of care delivered via phone calls and Skype<\/a>. But as the highly contagious COVID-19 forced people to practice social distancing, leaving office visits out of the question for most, the government\u2019s hand was forced.<\/p>\n\n\n\n

The unprecedented changes started rolling out as early as March 6 when President Donald Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which empowered U.S. Department of Health and Human Services<\/a> to waive certain Medicare requirements to expand access to telehealth and reimburse providers for virtual office visits.<\/p>\n\n\n\n

Telehealth access grew further on March 13 when Trump declared the pandemic a national emergency, allowing HHS to temporarily drop requirements for telehealth consultations, let providers work in states where they don\u2019t have licenses and allow rehabilitation centers to accept patients without a minimum hospital stay.<\/p>\n\n\n\n

On March 17, HHS’s Office for Civil Rights waived potential penalties for violations of the Health Insurance Portability and Accountability Act resulting from “good faith provision of telehealth.”<\/p>\n\n\n\n

In the days that followed, HHS cleared hospitals to share telehealth equipment, permitted emergency departments to use telehealth for the assessment of patients\u2019 treatment needs and extended Medicare coverage tomore than 80 additional services like radiation management and physical therapy.<\/p>\n\n\n\n

And by March 30, the Federal Communications Commission<\/a> was funneling $200 million into not-for-profit and teaching hospitals, clinics and local health agencies to support telehealth as part of the Coronavirus Aid, Relief and Economic Security Act.<\/p>\n\n\n\n

While the government has stressed that the revamp will be over as fast as COVID-19 passes, experts say some of the changes are here to stay.<\/p>\n\n\n\n

\u201cMedicare has been clear the waivers are only for the public health crisis that we\u2019re in and don\u2019t expect these to stay, but I don\u2019t think that\u2019s going to be reality. The train is out of the station,\u201d Allison Shuren, co-chair of the life sciences and health care regulatory practice at Arnold & Porter<\/a>, told Law360. \u201cNow that we\u2019ve used these services and have millions of people who are comfortable with them on the health care provider and patient side, there\u2019s going to have to be a conversation.\u201d<\/p>\n\n\n\n

Once the pandemic is in the rearview mirror, HHS will have to engage in notice-and-comment rulemaking to permanently implement the measures it has already utilized, but that doesn\u2019t mean the basic intent of the regulatory changes will be tossed aside, Shuren said.<\/p>\n\n\n\n

\u201cWhat\u2019s being built out now, even though it\u2019s in a rush, will not just get thrown in the trash afterwards,\u201d said T.J. Ferrante, senior counsel at Foley & Lardner LLP<\/a> and a member of the firm\u2019s telemedicine and digital health industry team. \u201cIt\u2019s going to be the toe that dips in the water to get a lot of virtual care programs up and running.\u201d<\/p>\n\n\n\n

Changes in Medicare reimbursement and the standard of care are likely to stay in place because of the real-world impact that has already been made by the telehealth rollout, Ferrante said.<\/p>\n\n\n\n

\u201cIf you\u2019re seeing a doctor using virtual care, they\u2019re out of state, they don\u2019t have a state license and they\u2019ve been treating you for the past 30 days, I don\u2019t think all of a sudden that\u2019s going to be cut off without any continuity-of-care consideration,\u201d he said.<\/p>\n\n\n\n

And commercial payers that have previously shown reluctance have also been forced to join the march toward telehealth, with insurers like Aetna<\/a> and Blue Cross Blue Shield recently announcing expanded access to telehealth during the pandemic.<\/p>\n\n\n\n

\u201cPayers are not going to be able to hide anymore,\u201d Shuren said. \u201cIt\u2019s going to be a fascinating time once we get on the other side of this disaster.\u201d<\/p>\n\n\n\n

But while attorneys hope telehealth’s success at the federal level will stay the same in the wake of COVID-19, they\u2019re less optimistic that states will hop on the bandwagon.<\/p>\n\n\n\n

\u201cThere are plenty of states where their licensing rules, scope-of-practice rules and medical practice acts are not up to speed,\u201d Vasquez said. \u201cWe need clarity for those who want to do services across state lines.\u201d<\/p>\n\n\n\n

Most states don’t allow out-of-state physicians to practice within their borders without state licenses, even during a public health emergency. In response to that lack of uniformity, HHS Secretary Alex Azar and the National Governors Association<\/a> recently voiced support for broader use of telemedicine during the pandemic. It remains to be seen whether states will make changes, and there\u2019s likely little room for the federal government to step in to craft a uniform standard for licensing.<\/p>\n\n\n\n

\u201cAt least right now, we don\u2019t see any federal preemption,\u201d Vasquez said. \u201cIt\u2019s within the states\u2019 hands. The practice of medicine is a politically sensitive area.\u201d<\/p>\n\n\n\n

Georgia, Iowa, Missouri and Nebraska are among states with loose licensing standards and don’t appear to have a lot of restrictions in place for telemedicine. They could be a model for other states, Vasquez said.<\/p>\n\n\n\n

\u201cIf states see others taking action and think they\u2019re behind on the issue, you may see some momentum,\u201d he said.<\/p>\n\n\n\n

\u201cI\u2019ve always viewed those really as turf issues and money revenue generators for boards of medicine and boards of nursing,\u201d Shuren said of states\u2019 varying policies regarding telemedicine. \u201cShould we be rethinking our infrastructure for licensure around telehealth to be less restrictive than it is in some of the states now?\u201d<\/p>\n\n\n\n

Despite its newfound glory, telehealth still faces thorny questions about patient privacy, medical malpractice insurance costs and payment parity among private health insurers. But what has been established over the past few weeks has laid out a strong case for how the industry can proceed, experts say.<\/p>\n\n\n\n

Riverwood Healthcare Center in the 2,000-person town of Aitkin, Minnesota, is one of many providers that quickly mobilized telehealth to treat patients as stay-at-home mandates and travel restrictions nationwide made in-person treatment inadvisable.<\/p>\n\n\n\n

The rural hospital selected a platform \u2014 Zoom for Business \u2014 that it had already been using for meetings, implemented the telehealth network, perfected workflow and within days started treating patients from 1 to 96 years old, according to a case study released by the American Hospital Association<\/a>.<\/p>\n\n\n\n

What unfolded at Riverwood is a reflection of how hospitals, physician practice groups and small-town family doctors have responded to the crisis after the federal government rolled out the measures to help telehealth get off the ground.<\/p>\n\n\n\n

\u201cI\u2019ve never seen anything like this before in the whole health care industry,\u201d Ferrante said. \u201cIt\u2019s showing the world what telehealth can do. There are a lot of people who have argued against telehealth. A lot of those arguments are going to be less credible now that we\u2019ve seen it in action.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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