Due to the outbreak of coronavirus disease (COVID-19) that was first reported in Wuhan, China, on December 31st, 2019, the public is turning to telehealth to prevent further spread of the virus. Telehealth is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care. Telehealth software allows healthcare providers to conduct consultations with patients while both parties maintain a safe distance, preventing the spread of the virus.
Payers & Telehealth
Before the COVID-19 crisis, some private health insurance providers covered telehealth consultations, though this significantly varied by the payer and across states. If telehealth consultations were covered, they were usually at a lower reimbursement rate.
Medicare would cover telehealth if the patient lived in a “health professional shortage area” that is outside a metropolitan area. Medicare also required that patients go to a designated healthcare facility to initiate a video visit. After the initial e-visit, the patient and their local provider could connect using telehealth technology. Video visits from home, or anywhere that was not within a designated “originating site,” were not covered under Medicare.
Medicaid’s telehealth coverage was based on state laws, as the federal Medicaid statute does not recognize telehealth as a distinct service. Telehealth was viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care. Fifty states and Washington, DC, provided reimbursement for some form of live video in Medicaid fee-for-service.
Families First Coronavirus Response Act & telehealth
Due to the COVID-19, healthcare authorities have urged the public and healthcare organizations to make use of telehealth software. The federal Families First Coronavirus Response Act passed on March 18th, 2020, requires payers to waive the amount an individual would pay for telehealth. USA President Donald Trump announced that “Medicare patients can now visit any doctor by phone or videoconference at no additional cost, including with commonly used services like FaceTime and Skype.” During the pandemic, health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur in the good faith provision of telehealth.
Barriers that previously interfered with the use of telehealth software have been removed during this time. With the recent passing of the Families First Coronavirus Response Act, patients are not required to pay for telehealth consultations related to COVID-19 testing and treatment. Additionally, public knowledge of telehealth software capabilities has significantly increased. Patients are now seeking alternatives to reduce their costs associated with COVID-19 testing and treatment, and will likely become accustomed to the convenience of receiving care via telehealth. Furthermore, the new Interoperability and Patient Access final rule legislation promotes secure and straightforward access to personal health information by patients through ubiquitous technologies such as smartphones. And the trend in mobile app implementation by healthcare providers will further drive the adoption of telehealth.
Telehealth & Healthcare Organizations
Telehealth may seem like a new concept fueled by COVID-19, but in reality, telehealth software companies have been around for many years and are growing in popularity. (The expectation is that the changes as mentioned above will rapidly drive growth.)
CareClix was founded in 2010 and works with qualified practicing physicians to provide a wide range of telehealth services. CareClix accepts Medicare, Medicaid, and most private insurance plans.
MDLive was founded in 2009 and has multiple partnerships within healthcare systems across the United States; they also accept some health insurers, including Blue Cross Blue Shield (BCBS). MDLive provides the public with healthcare professionals who are available by phone or online video 24 hours a day to help patients answer questions about non-emergency related medical conditions.
In both cases, these companies are staffed with their own physician network. This means that they provide telehealth software and physicians. There are other vendors in the market that provide only the technology, which is then purchased by healthcare organizations to be used with their own physician network. Bridge Patient Portal is an example of a vendor that provides a platform for healthcare organizations to offer telehealth services to patients using their private providers. It’s essential to recognize the difference in approach here. There are many considerations in terms of the pros and cons of each model. There’s a risk when physicians step out of their primary care provider’s (PCP) network and go to a random telehealth provider for their care. One could say that when a patient’s private insurance company is promoting their own telehealth provider, they are essentially circumventing the patient’s PCP. An example of this is BCBS’ partnership with MDLive, where patients are encouraged to seek care outside of their PCP.
Unless brick and mortar healthcare organizations adopt telehealth platforms, they may lose the business of their patients. The rapid growth in demand for telehealth, and circumventing by private healthcare insurance companies, are leaving healthcare organizations scrambling to provide their patients with telehealth software. As a temporary solution, healthcare providers can leverage traditional video conferencing platforms for e-consultations. Once the crisis has subsided, healthcare providers will likely no longer be able to use telehealth in this manner — as the HIPAA waiver expires. In addition, healthcare providers will no longer be reimbursed for telehealth services through video conferencing platforms. Given the many challenges that exist today in sharing health records, it’s preferred that patients seek care with the same network of providers to reduce the duplication of care and diagnostic testing. But if a patient’s PCP can’t provide telehealth, they may be forced to seek care elsewhere.