Flattening the Curve Through Telemedicine

Telemedicine has new and profound importance due to the COVID-19 crisis.  “Virtual” healthcare preserves patient protective equipment that would otherwiimage_4-e1587393250939se be used and allows physicians to manage chronic illnesses remotely, without the in-person interaction that exposes provider and patient to the risk of spread. This increased reliance on telemedicine has prompted state and federal legislative bodies to pass new rules and guidelines to promote access to telehealth services by reducing costs, increasing availability, and promoting relationships between healthcare providers and their patients.   Our Georgia-based business and healthcare law firm follows regulatory developments that impact healthcare providers.  As of the date of this post, seven states (Arizona, Florida, Kansas, Maine, New Jersey, Oregon, and Utah) have waived restrictions on telehealth. More relaxation of telehealth rules may be expected.

 New Regulations: an Overview

Virtual medicine is expected to aid in slowing the spread of coronavirus by limiting contact between individuals.  New telemedicine regulations encourage video and audio conversations between providers and their patients.  Telemedicine platforms can serve a variety of functions, some assist with managing patient triage, while others provide alerts to providers and patients in regard to medication management.  Other platforms allow for effective monitoring of chronic illnesses for patients, even with the strict social distancing guidelines that are currently in place. Thus, as part of an effort to allow healthcare providers to better support each other and their patients, the federal government has reduced the regulatory hoops that have previously limited access to Telehealth services. The CMS Fact Sheet discusses in depth the changes that have been made to provide virtual services.

Some of the recent changes are as follows:

  • Stark Law modifications promote sharing of devices and sales at below market value;
  • Out of pocket costs or copays for new and established patients can be waived;
  • Federally Qualified Health Centers and Rural Health Centers are now eligible providers for telemedicine services;
  • 80 new telemedicine services can be reimbursed under Medicare;
  • Other providers (physical therapists, occupational therapists, and speech language pathologists) can now bill virtual check in codes. These codes are lower reimbursement rates and are only to be “brief check in’s” with patients.

HIPAA compliance has been an additional concern for providers seeking to add telemedicine to their services. HHS addressed those concerns in a recent announcement. Now, covered health providers may utilize popular applications to connect with patients (Apple Facetime, Zoom, Facebook Messenger) without facing penalties if the application is not compliant with HIPAA. The Office of Civil Rights Director Roger Severino summed up HHS’s efforts as follows, “We are empowering medical providers to serve patients wherever they are during this national public health emergency. We are especially concerned about reaching those most at risk, including older persons and persons with disabilities.”

 The Trend

Recently, health insurance companies and hospitals have directed patients towards Telehealth programs. For example, in New York, NYU Langone Health added 1300 providers to their telemedicine platform, and conducted 3500 visits to patients during one week in March. Similarly, UMass Memorial Medical Center has been offering Telehealth visits for ambulatory care, once a patient schedules a visit online.  Houston Methodist created a telehealth training center and has trained more than 500 physicians virtually and at the hub. The shift that is occurring is creating a rapid hiring need for telemedicine companies. Teladoc. Doctors on Demand and other companies are hiring physicians at a rapid rate.

Physician Practices

For healthcare practitioners and providers who have not previously utilized telemedicine to interact with patients, new regulations may be confusing to navigate.  In the midst of these unprecedented times, the fluidity of weekly changes create uncertainty of how these services will be provided and how physicians will be reimbursed.  Small physician practices have increasingly contracted with virtual medicine companies, since patient volume in small practices has decreased in response to the outbreak. Telehealth services can keep small practices afloat, since the government has relaxed Medicare and Medicaid reimbursement rules to engender compensation for virtual visits.  The American Medical Association has provided a guide for how to successfully bring telemedicine services to existing practices, including these five tips:

  • First, check with your EHR vendor to see if there is an existing feature for telemedicine.
  • Check your state health department or state medical association to stay up to date on the most current regulations.
  • To ensure that virtual medicine can be most effectively implemented, choose a team to be responsible specifically for that process.
  • Train care team members and schedulers on when telemedicine visits should be conducted.
  • To be able to provide virtual care to patients located outside of state, fill out a Medicare or Medicaid Waiver that halts licensure restrictions.

We’re Still Falling Short

While the utilization of virtual medicine may be “flattening the curve”, not having enough doctors available to meet patients’ needs is an issue that is challenging hospitals and medical practices. Patients have reported waiting more than 20 hours to see providers, before appointments have been cancelled. Some rural hospitals have been unable to reach patients using telehealth services. The additional expense for implementing a telehealth program poses unique difficulties for smaller hospitals, who keep limit cash on hand and are attempting to keep up with payroll. In response to these issues, the Federal Communications Commission (FCC) has proposed a 200M program that will better equip providers for the transition to virtual medicine. Additionally, a three year “Connected Care” pilot program would devote $100M to increase broadband connectivity, and update information services to meet the needs of patients.

Nationwide efforts are being made to ensure that telemedicine is able to reach its maximum level of effectiveness. Collaboration between legislators, hospitals, physicians, and telehealth companies during this epidemic will pave the way for the future of telemedicine within the United States. The prompt shift towards virtual healthcare may in fact be one of the lasting consequences that has stemmed from the 2020 COVID-19 epidemic.

Our business and healthcare law firm will continue to provide updates on telemedicine and other relevant developments.  If you have questions about this post or our law firm, contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may learn more about our law firm by visiting www.hamillittle.com.

**Disclaimer: Thoughts shared here do not constitute legal advice. Please consult with an attorney to discuss your legal issue.

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