Adopting a ‘computer-side’ manner
Any practice offering telemedicine should be training their staff, as virtual meetings require certain skills, Dr. Peoples stressed. “You have to have experience as a rheumatologist, but you also have to have experience in telemedicine. Then it’s about merging those two skills.” Physicians need to be familiar with the technology and equipment. “I have a Bluetooth stethoscope that hears the heart and the lungs” of a patient during a virtual visit, she said.
Most importantly, physicians need to adopt a “computer-side” manner. “Make sure you have good eye contact on the screen, that you’re maintaining a good, professional relationship with the patient.” Training nurses to assist doctors during a telehealth visit is also key.
Dr. Peoples said UPMC has been training its fellows in telemedicine to adopt these skills.
Efforts to pay doctors for telehealth
As rheumatologists navigate the growing market for telehealth, questions remain about the long term payment outlook for these services.
For now, there appears to be reimbursement parity for telehealth visits, Dr. Feldman said. COVID-19’s public health emergency put into place certain flexibilities for telehealth. But some concerns remain about the commercial insurance sector. Whether private payers will continue paying the same amount as they do for in-person visits once the pandemic is over is unknown, Dr. Feldman added. “Insurance companies have had a boom in profits and should not be able to use ‘losses’ from COVID as an excuse for stopping pay parity for telehealth visits.”
David Allen, spokesperson for America’s Health Insurance Plans, said some plans are voluntarily offering telehealth payment parity during the public health emergency. “However, as a policy, AHIP does not support mandating that clinicians be paid the same amount for telehealth and in-person care,” Mr. Allen said, adding that AHIP hasn’t tallied how many insurance companies offer payment parity. “Too many variances exist between plans to make any kind of declarative statement on this.”
For her telemedicine visits at teleconsult centers, Dr. Peoples said compensation is comparable with traditional in-person visits. “Compensation is different for video visits where the patient is at home. However, these video visits are still reimbursed by most insurance plans.”
Federal payers and many states have taken actions on parity. Telehealth is seeing major legislative action at the state level, Kelly Hughes, a program director for the National Conference of State Legislatures, said during the CSRO meeting. All 50 states, the District of Columbia, and Puerto Rico have made revisions to telehealth policies during the COVID-19 pandemic to maintain access to health care services and to minimize potential exposure. Most of these are temporary modifications to address the pandemic, but some states are either adopting permanent changes or mulling over permanent changes to telehealth, Ms. Hughes said.
Modifications vary widely by state, but the top three trends include allowing reimbursement for phone calls (not requiring video), expanding the types of providers authorized to provide telehealth services, and allowing a relationship between a patient and provider to begin with a telehealth visit.
The Commonwealth Fund reports that at least 13 states have enacted payment parity laws in response to COVID-19. Another four had parity laws in place prior to the pandemic. “Many states have taken direct action via Medicaid policy; all but two issued specific guidance on the expansion or reimbursement of Medicaid-based telehealth services,” according to the Commonwealth Fund.
In Texas, where Dr. Monga practices. Gov. Greg Abbott (R) has temporarily waived regulations to lift certain telehealth restrictions. The Texas Department of Insurance under an emergency rule is directing state-regulated health plans to cover telemedicine visits at the same rate as in-person visits during the COVID-19 emergency declaration. “This has helped expand our telehealth options in Texas,” Dr. Monga said.
Medicare has also boosted coverage of telehealth services. “I appreciate that the Centers for Medicare & Medicaid Services has acknowledged the value of telehealth services by reimbursing for audio-only visits at the same rate as audiovisual and in-person evaluations during the public health emergency,” Dr. Monga said.
CMS has also proposed to expand telehealth access in its CY 2021 Physician Fee Schedule Proposed Rule. Additionally, the Department of Health & Human Services Office of Rights will not be penalizing physicians for HIPAA noncompliance for conducting visits through technologies such as FaceTime or Skype during COVID-19, she added.
While telehealth can’t replace all in-person visits in rheumatology, “it can certainly provide us with support during certain circumstances, as we have learned during the current health emergency,” Dr. Monga said. “I hope that even after this crisis has passed that parity for telehealth will be maintained and we can make permanent some of the current updates.”