Telemedicine is in the midst of a flashbulb moment. Just as Americans’ reference “before/after 9/11” to describe how September 11, 2001, forever changed the way we travel, in the not-so-distant future, we will make reference to “before/after COVID-19” to describe the public health emergency and how it forever changed the way we provide and receive medical care.
As this article is being written, and likely as you are reading it, health care entities throughout the United States are quickly reorganizing their operations to address the COVID-19 public health emergency. Almost without exception, this reorganization includes converting what were previously in-person clinics, consultations, procedures, and follow-ups to operate remotely, at a distance, via telehealth and telemedicine. As a result, demand for telemedicine equipment has skyrocketed. Telemedicine equipment manufacturers are ramping up production as much as three times their annual production rates. Likewise, investors are taking note and opening up their capital to telehealth and telemedicine investments. All the while, patients and providers are being exposed to telemedicine en masse. In short, telemedicine is experiencing the perfect storm.
It is worth noting that telemedicine and telehealth were already well on their way to full adoption by the medical community at the time that COVID-19 first appeared. According to the American Telemedicine Association’s “State of the States” Report for 2019, every state in the United States has made progress in some regard concerning telehealth and telemedicine since 2014, whether it be by expanding Medicaid eligibility and reimbursement, providing coverage for synchronous and asynchronous telehealth technology, expanding the list of providers who can be reimbursed for telehealth, increasing coverage parity and payment parity, or implementing innovative payment models. Similarly, industry reports prior to COVID-19 continuously reflected increased investment in telehealth, telemedicine, and remote patient monitoring by investors. Absent the current pandemic, 2020 already promised to be THE decade for digital health. However, now, rather than being driven by consumer demand, political will, or investment potential, telehealth and telemedicine are being driven by the most important factor of all: necessity.
In only a few short weeks, governments at all levels have implemented policy waivers and reforms, albeit only temporarily, that would have taken a decade to implement under normal circumstances. These waivers allow for the provision of telemedicine medical services and telehealth services like never before while the emergency declarations are in effect. The U.S. Department of Health and Human Services Office of Civil Rights has implemented unprecedented waivers to the enforcement of HIPAA with regard to both telehealth platforms and business associates agreements. CMS is allowing the patient’s home to serve as an eligible originating site for the purposes of reimbursement. The CMS requirement that a doctor of medicine or osteopathy be physically present to provide medical direction, consultation and supervision of services has been waived for critical access hospitals, allowing physicians to supervise remotely through telephone, radio or electronic communication. Governors and state governments throughout the United States have implemented waivers to the methods by which a practitioner-patient relationship can be formed to make it easier to establish the relationship via telehealth. Waivers have been made to DEA rules for prescriptions of controlled substances. And so the story goes throughout the regulatory system.
Meanwhile, providers and practitioners throughout the United States are serendipitously participating in one of the largest practice reforms their profession has ever experienced. Thousands of providers, both those who would and would not have otherwise elected to provide care via telemedicine, have been thrown in the deep end of the pool with minimal guidance and must engage in experiential learning by actually practicing telemedicine. Similarly, interprofessional teams of clinicians and office staff are discovering new ways to coordinate services and operations at a distance. IT departments, compliance departments, and offices of legal counsel have received crash courses in telemedicine and telehealth compliance and security. And patients are becoming more familiar with telehealth services and the variety of clinical applications of telehealth technology.
The importance of the patient and provider experience throughout this pandemic cannot be understated. For decades, Americans have perceived medical care as an almost Norman Rockwell style experience, with a brick and mortar clinic, physicians in white coats with analog stethoscopes, and a sucker at the end for kids who are well behaved. Now, for the first time, hundreds of thousands or even millions (we’ll know once the pandemic has ended and claims can be evaluated) of Americans are being exposed to telehealth. I cannot count how many friends and family have regaled me with stories of their first-time experiences, or a loved one’s first experience, with telehealth and telemedicine over the last two months (due to the nature of my employment, I’m quickly becoming the go-to person to share this information with amongst my friends and family). Without exception, their stories have been overwhelmingly positive and they even have an energetic and curious quality when discussing the uniqueness of their experiences when compared to traditional in-person visits. These experiences, more so than policy and investment, are what will drive telemedicine and telehealth forward in a post-COVID-19 world, because these experiences are changing Americans’ cultural expectations, and those cultural expectations are what will inform policy reform and signal to investors that telemedicine is a stable and worthwhile investment. For years, Americans have been deeply involved with and aware of the digital realm through social networks, remote work agreements, and devices that can reach across the globe at the touch of a button. Now, with an extra push from COVID-19, Americans are increasingly viewing their health care through a digital lens as well.
COVID-19 will likely be contained and begin to decline over the coming months, eventually fading from the forefront of our public consciousness. However, the impact it has had on our health care system will remain long after the public health emergency has dissipated. We are all currently participants in a great experiment – implementing and waiving policies and procedures ad hoc in order to meet the needs of public health, the consequences of which will only be fully appreciated after the fact. In many ways, COVID-19 has exposed the extent to which our health care system has, to date, prioritized form over function. When the dust settles and we finally look back to evaluate how the emergency has affected health care delivery, operating costs, incomes, and patient outcomes, the resulting data will undoubtedly be used to advocate for reforms that encourage greater implementation of telemedicine and telehealth, including permanent implementation of many of the temporary waivers currently in place. As we begin to return to “normal,” it will not be the same normal as before. Rather, it will be a new normal. A normal in which the public will increasingly expect virtual access to their care when and where they need it; and a normal in which health care entities, regulators, and payers, battle hardened by the COVID-19 pandemic, will have the infrastructure, protocols, and procedures in place to provide that care virtually using telehealth and telemedicine.