Which Telehealth Changes Will Become Permanent? Hints May Come Next Month

Four months since the start of the public health emergency arising from the coronavirus disease 2019 (COVID-19) pandemic, one of the most acknowledged silver linings for providers and patients is the expanded use of telehealth. During a session on telehealth at the National Association of ACOs (NAACOS) 2020 Virtual Spring Conference, viewers were told to look at the proposed 2021 Medicare Physician Fee Schedule to see which changes might become permanent even after the health emergency ends.

Emily Yoder, a CMS analyst in the Division of Practitioner Services who works on the fee schedule, said the department recognizes that practices had to shift rapidly and that the flexibility enabled by CMS spurred “a lot of innovation in terms of care delivery.”

“And so what we really want to avoid is a situation where the [public health emergency] ends and then it is like a rug is pulled out and everything goes back rapidly to sort of the pre–public health emergency regulations,” she said.

Some changes, if they were to become permanent, would require Congressional action, whereas others lie in CMS’ regulatory domain.

Yoder encouraged conference participants to submit a public comment on the fee schedule when it is released next month so that CMS can incorporate their thinking.

Ronald Tamler, MD, PhD, MBA, an endocrinologist and director of Digital Health Implementation at the Icahn School of Medicine at Mount Sinai, said that before the pandemic, telehealth was an unattractive afterthought to physicians.

In February 2020, there were just 63 providers conducting video visits with patients. By the end of the next month, the number had soared to 1173.

That is because by mid-March, “Mount Sinai said, ‘This is a war. We’re going to war. We’re going to make this all about [intensive care unit] beds and patient capacity, and we’ll have to figure out a way to provide ambulatory care for our patients.’”

The loosening of the regulatory restrictions was important for a place like Mount Sinai, which has patients in New York, New Jersey, Connecticut, and Florida.

Tamler ran through a series of practical tips in order for providers to have a successful video visit with patients. Remember to smile and maintain eye contact, he said, since there are limited ways for doctors to connect with patients during a video visit.

Visual inspection through the camera can yield findings from more than a dozen areas, he said. Physicians can also ask patients or caregivers to be assistants during the exam, such as by depressing their own shins to determine the extent of swelling or putting the camera on the floor to show their feet to check for ulcers. Rulers or coins can document the size of lesions.

However, Tamler noted that the COVID-19 crisis is also worsening disparities when it comes to access to telehealth among the populations that are most affected by the pandemic, such as the elderly and those with poor technology at home, suboptimal technological literacy, and little or no English.

Besides telehealth, Mount Sinai is also using Epic eConsults to consult with more than 25 different ambulatory specialists as well as a text-to-chat platform for 3 groups of patients: patients recently discharged with COVID-19, patients of Mount Sinai’s value-based care practice, and oncology and cardiology patients.