As the novel coronavirus spreads around the country, US agencies like the Centers for Disease Control and Prevention are encouraging people who feel sick to first talk to doctors remotely, by video or phone, to avoid filling waiting rooms.
The $8.3 billion bill funding the US response to the virus opens those remote services to people on Medicare — that is, US adults over the age of 65. The bill gives the gives the Health and Human Services Secretary the power to suspend rules that restrict their access to remote care, or telehealth.
“That was really earth-shattering news for those of us in telehealth,” says Peter Antall, chief medical officer of telehealth provider American Well. “It’s right on target, as far as we’re concerned. This is the patient population most at risk for complications.”
There are major benefits to virtual care during outbreaks like this one: it keeps people who might be infected out of waiting rooms, where they might infect others; it’s fast; and it lets experts see patients in a wider geographic area.
Normally, Medicare patients wouldn’t get those benefits. For doctors to be reimbursed through Medicare for telehealth visits, patients can only be located in certain rural areas, and have to be in a health facility — they can’t use a telehealth service from their home. But because older adults are especially vulnerable to COVID-19, the illness caused by the novel coronavirus, the risks of a hospital visit are particularly high for Medicare patients.
“The only way they can get care is to hop in a car and drive to a health center,” says Rusty Hofmann, chief of interventional radiology and medical director of digital health care integration at Stanford University School of Medicine. Those barriers are in place because legislators are concerned about Medicare fraud and abuse.
During this outbreak, though, patients need to be assessed quickly. “The decision every doctor is making, and that would be greatly enhanced by video, is does this patient need to be admitted to the hospital or can they be taken care of at home,” Hofmann says.
In response to the COVID-19 outbreak, Stanford Health Care has started offering video visits to non-Medicare patients with respiratory symptoms. “We’ve already seen quite a lot of patients, and doubled our capacity,” says Leah Rosengaus, director of digital health at Stanford Health Care.
American Well has seen an 11 percent uptick in the use of their services over the past few weeks, and they’ve already referred around 20 to 30 patients for COVID-19 testing, Antall says. They have protocols in place to help patients safely get to the emergency room without exposing others. “We’ve not been made aware of any positives yet,” he says. “However, quite a few of the high risk cases we’ve seen have been in Washington state and northern California. Some are high, high risk. It would not at all be a surprise.”
Antall says the service is also seeing more patients who need regular health care, but don’t want to go to a doctor’s office. That’s another benefit of telehealth: it lets vulnerable people stay away from places where they might be exposed to the virus. That would be particularly useful for elderly patients on Medicare. “During these types of outbreaks, you really don’t want to go where people are sick,” Hofmann says. If people can be treated virtually for other, non-infectious conditions, that also leaves space in health care facilities for patients fighting the virus.
The telehealth provision in the coronavirus funding bill may help some Medicare beneficiaries access beneficial virtual care. The bill also allocates $3 billion for research into a vaccine and other treatments. President Trump signed the bill on Friday.
But it includes a stipulation: for a patient to use telehealth services in this emergency situation, they would have to have seen a doctor at that facility for another reason at some point in the past three years. That may create logistical problems for hospital systems. “Trying to see if a patient has been here would be an auditing nightmare,” Hofmann says.
It also limits the ability of people who recently moved to the area, or who for whatever reason have not been able to see a doctor in the past few years, to receive those services. Groups that provide purely telehealth services, like American Well, also won’t benefit from the waiver. “It doesn’t look like there’s a clear path forward,” Antall says. It’s good news, though, that hospitals and clinics that also offer in-person care will be able to open their telehealth services to their Medicare patients, he says.
If Medicare’s restrictions around telehealth were dropped for the duration of the ongoing public health emergency, first and foremost, it would improve patient care, Hofmann says. But it would also be a kind of probationary period for Medicare and the technology. Regulators could potentially use the temporary loosening of rules to see if expanding telehealth access was actually facilitating fraud or abuse, Hofmann says. If it went well, it could bolster the case of people pushing for longer-term changes — including the passage of the CONNECT Act, first proposed by a bi-partisan group of senators in October. The bill would expand the telehealth services covered by Medicare.
“For those of us in this digital health space, we know it’s a problem, and it’s not the right thing for patients,” Hofmann says. “If access to easy and affordable health care can happen digitally, we should encourage the federal government to allow it.”