In a deepening crisis, it’s only natural to search for dim rays of light amidst the prevailing darkness. One such glimmer might, in fact, be the increasing reliance upon telemedicine in our brave new world of social distancing.
The inherent value of telemedicine is readily apparent in the context of an acute public health challenge that is being addressed primarily by limiting face-to-face human interaction. From the beginning, telemedicine has offered convenient and prompt access to medical professionals via your laptop computer; now add to these attributes the ability to avoid risks presented by a full waiting room of other patients who may be shedding a viral load.
Telehealth concept is represented by a doctor remotely consulting with his patient.
Let’s say you awake feeling poorly, and after consulting government websites with generic information, your specific questions remain unanswered. How do you formulate a medical action plan? Do those flu-like symptoms suggest that you might have contracted COVID-19? Should you get a diagnostic test? Is one available in your area? Do you need a doctor’s referral or order to get one?
With this backdrop, patients would seem to have more reason than ever to dial up a doctor on one of the many telemedicine portals that have developed in the last few years. Some examples are SnapMD, SOC Telemed and Teladoc Health.
Could this be the telemedicine moment?
One of the leading telemedicine providers, Amwell, has seen explosive growth rates of telehealth usage correlated to the movement and impact of the virus. Amwell’s President and Chief Medical Officer Dr. Peter Antall said that they have experienced more than 1000% increase in virtual visits overall with even higher surges in some parts of the country.
“Many of our partners are using telehealth as the front line for screening and triaging patients. . . . For high-risk patients, we are working with public health authorities and our ecosystem of partner hospitals and health systems to coordinate and refer care accordingly. But a large fraction of patients for whom telehealth is critical is those who are chronically ill and unable or unwilling to risk themselves by seeing a doctor. Telehealth can be a part of the democratization of care, enabling them to see their providers from the safety of home without unnecessary exposure or risk,” said Antall.
This theme was echoed by PlushCare CEO Ryan McQuaid, who founded the San Francisco-based company and started seeing patients in 2015. In addition to COVID-19 related inquiries, they have also seen a significant increase in patient consults from those who suffer from chronic conditions like asthma, who are being told to stay away from doctor’s offices and hospitals but need medical care.
PlushCare has seen their total visits double since the onset of the virus and McQuaid thinks that telemedicine is tailor made to address the challenge of our times. “People need targeted medical advice that is specific to their circumstances, while adhering to social distancing guidelines. Virtual care using a telemedicine platform should be the first choice in maintaining safe distance between patient and provider. We can’t offer an at-home diagnostic test, but we are providing information and guidance to advise patients on their symptoms and testing options, while helping to protect especially vulnerable populations,” he said.
In contrast to some telehealth providers, PlushCare is focused on primary care, and their model pairs patients with a dedicated primary care provider. McQuaid noted that many reside in rural or relatively remote exurban areas, what some call the primary care “desert.” An estimated 50% of Americans do not have a primary care physician, and those who seek a primary care practice often encounter significant delays and frustration in the process of coverage and scheduling the initial appointment.
In the United States there are about 600 million primary care visits each year, and only a small percentage (perhaps less than 2%) of these are conducted using telemedicine platforms. This modest proportion reflects regulatory and reimbursement challenges that have limited the growth of telemedicine. For example, physicians are licensed to practice under state law and telemedicine firms need to structure their consults in a way that does not run afoul of these professional licensing requirements. In addition, there are inconsistent policies and practices concerning private insurance coverage for telemedicine. 39 states have enacted so-called parity laws that require that private insurers pay for telemedicine services, but in the holdout states it remains the payer’s prerogative and prior authorization often is required to obtain coverage.
U.S. President Donald Trump, right, holds up a signed $7.8 billion emergency coronavirus spending ... [+]
On Friday March 6, President Trump signed into law emergency funding legislation that also included a provision that allowed HHS Secretary Alex Azar to lift restrictions on Medicare beneficiaries using telehealth services during national emergencies.
The Centers for Medicare & Medicaid Services (CMS) followed by waiving requirements, retroactive to March 1, to temporarily permit doctors and other healthcare professionals to offer services (including telemedicine consults) across state lines. And Blue Cross Blue Shield has announced that its member affiliates will waive co-pays and other patient costs associated with telemedicine services.
Antall applauded these efforts but emphasized that much needs to be done. “Many of the moves have been enacted on an emergency basis only . . . [but we] believe that when this outbreak recedes, the various stakeholders (government, health plans, health systems, providers) will all align and realize that telehealth must be an integral and permanent part of modern healthcare delivery.”
