Expansion of Telemedicine Access During COVID-19 and Future Policy Changes
Before the COVID-19 pandemic in 2019, telemedicine was limited to provider restrictions and geographic locations. However, in efforts to contain the spread of the coronavirus, authorities and telemedicine providers expanded and even encouraged telemedicine access across the country. Medical service providers, private insurers, physicians, and patients turned to telemedicine as a safer alternative to in-person treatment.
Now that the pandemic is under control and emergency rules are coming to an end, it is clear that telemedicine and virtual healthcare is here to stay. Remarkably, the pandemic was an incentive that accelerated the adoption and expansion of telemedicine at an unprecedented rate.
According to stats published by the Centers for Medicare & Medicaid Services (CMS), approximately 15,000 beneficiaries of Medicare used telemedicine services each week before the pandemic. Most of these beneficiaries were patients living in rural areas with limited access to in-person medical services.
However, between March and October of 2020, the number of beneficiaries who enrolled for telemedicine services had risen to a whopping 24.5 million.
Telemedicine Policy Changes During the Pandemic
Lockdowns and other social distancing rules put in place to curb the spread of the Coronavirus forced many people to stay home. Fearful patients and doctors keen on minimizing contact to avoid potentially exposing themselves to the virus canceled appointments and sought telemedicine services instead.
As a result, many medical service providers and medical insurance and payment companies put in place temporary policies to reimburse patients for inconveniences and additional costs of the new measures.
In support of the pandemic situation and social distancing rules, some regulations of the Health Insurance Portability and Accountability Act (HIPAA) were loosened temporarily to make it easier for physicians to attend to their patients using their technological devices of choice. Before the pandemic, the HIPAA did not reimburse service providers for the costs of telemedicine services.
Additionally, more changes were introduced to the HIPAA to make more service platforms HIPAA-compliant and to open up the use of smartphones and other devices for medical service provision. Most private payers were quick to follow Medicare’s lead, changing their reimbursement policies and embracing telemedicine as a mainstream medical service.
These new changes encouraged telemedicine services across all industries. For instance, manufacturers of telemedicine equipment such as remote vital monitoring, virtual stethoscopes, digital otoscopes, and HIPAA-compliant software ramped up their capacity.
Many service providers invested in various other technologies required to conduct remote visits and provide telemedicine services. According to a survey by Medical Economics, as many as 77% of doctors surveyed provided telemedicine services for the first time during the COVID-19 pandemic.
Telemedicine and Patient Privacy Regulation Changes
Patient privacy laws, particularly regulations in the HIPAA have for a long time been viewed as major hindrances to the adoption of telemedicine. They prevented many service providers from finding technology service providers to partner with to invest in secure and private platforms for telemedicine.
However, this problem was overcome when the Department of Health and Human Services through the Office for Civil Rights issued a notice of enforcement discretion on web-based scheduling of individual appointments in response to the pandemic.
The enforcement discretion was a big break that medical providers needed to fully invest in telemedicine services. It allowed doctors, clinicians, health facilities, and other stakeholders to use platforms that would otherwise be considered not HIPAA-compliant. Zoom, FaceTime, Google Meet and other telecommunication platforms became viable platforms to schedule and offer medical services remotely.
The new practical approach led to faster adoption of telemedicine services and eased the worries that service providers had. However, the underlying privacy concerns had not been addressed, and the move, though temporary, required further in-depth consideration for long-term use.
The expansion of telemedicine services required a more nuanced approach to handling privacy regulations. The early period of the pandemic proved that privacy concerns were not at the top of the list as far as meeting the medical needs of patients was concerned.
While the risks of privacy violations persisted, it marked the start of the process of revisiting HIPAA regulations to ensure that privacy concerns do not hinder medical care.
Telemedicine’s Licensing Red Tapes
To many people, telemedicine was to some degree familiar though uncommon in real-world practice before the COVID-19 pandemic. One of the main hindrances to the adoption of telemedicine was the state and federal licensing barriers. Geographic rules that govern medical licensing presented a problem to service providers who saw telemedicine as an avenue to attending to patients across state borders.
Before the pandemic, only three states – Ohio, Texas, and New Mexico had created telehealth licenses that covered telemedicine. A handful of other states including Vermont, Tennessee, and Arizona were a part of the Interstate Medical Licensing Compact that licensed physicians from out-of-state to provide telemedicine services within their borders.
In response to the telemedicine needs of the pandemic period, many states relaxed or completely eliminated the most demanding licensing requirements for telehealth and telemedicine services. The move enabled clinicians and physicians anywhere in the country to care for patients in any state in the country without jumping through hoops. The relaxed licensing regulations created a more permissive environment for telemedicine services despite there being no mechanisms to verify service providers.
Medicare and Medicaid policies were revised shortly after to regulate telehealth and telemedicine services and to protect patients and service providers. The Centers for Medicare & Medicaid Services instituted multiple regulatory changes including:
- Expanding eligibility to all Medicare recipients. Before this, only patients living in rural areas were eligible for telemedicine
- Allowing both existing and new patients to access remote medical services
- Expanding the list of recognized healthcare providers to include telemedicine-only providers
The change in licensing requirements and the consequent Medicare and Medicaid policy changes greatly improved access to telemedicine across the country when it was needed most.
Congress’s Commitment to Telehealth and Telemedicine
Telemedicine and telehealth, in general, proved to be a much-needed solution to a problem brought about by the pandemic. Despite temporary measures proving useful to necessitating patient access to medical service in a time of crisis, Congress has been slow in making the legal changes required to bring the services to the mainstream.
Various branches of telemedicine services that do not require physical examination have been quick to adapt to a temporary relaxation of licensing and legal requirements. However, it has proven a tad more difficult for Congress to pass the laws that will guide the other more demanding branches of telemedicine such as chronic care management that demand a lot more than a simple check-in or video consultation.
Over the past two years, members of Congress have demonstrated their concerns regarding the rising costs of healthcare, limited access for vulnerable patients, and the impact of technology on the future of medical services. One of their major concerns is that telemedicine is a lot more difficult to regulate, and as such, could lead to higher costs for patients in need.
Congress needs time to study and understand the impact of new technology on the lives of those they represent. Already, a new senate bill in the house seeks to extend Medicare Telehealth waivers introduced during the pandemic by two more years after the end of a public health emergency.
All eyes are on Congress to step up their efforts and pass the right legislation to remove all barriers to telemedicine. This will ensure that all patients – in both rural and urban areas – get remote access to quality medical services anywhere in the country.
Ultimately, Congress will have no choice but pass the legislation that defines the physician practices as the service location rather than the patient’s location. This would free telemedicine services to only seek licenses in their state rather than in the states of every patient they serve. This change is seen as the most critical to making telemedicine services accessible to patients anywhere in and outside the country.
The Future of Telemedicine Beyond Policy
The key to the future of telemedicine is a specific policy that is both physician and patient-driven. Telemedicine has proven not only to be convenient for patients but also showed the potential to bring many future benefits.
These benefits are critical to improving public health, necessitating patient access to the expert care of their choice, and relieving the pressure presently experienced by the healthcare workforce. Beyond the pandemic, and policy changes, the market will evolve and the technologies necessary to streamline the services will naturally evolve.
Presently, a number of notable health and medical care trends are already defining the future of telemedicine. Increased patient utilization, improved telemedicine technologies, and remote patient care that has proven convenient and affordable is quickly defining the medical industry in the country.
As of 2022, telemedicine adoption is on a constant upward trajectory, proving that both patients and physicians indeed do value the service. Telemedicine has led to higher instances of remote chronic management, a greater focus on mental health, and improved patient and physician experiences.
Other factors such as integrated data sharing and data processing innovations are also shaping the adoption of telemedicine services. Patients too, in attempts to simplify their lives, have embraced wearable technologies and privately invested in remote patient monitoring tools that have made telemedicine even more accessible. The technologies behind these capabilities have shown that the future of telemedicine lies beyond mere convenience but a part of the revolution of social change.
MyHST is a wholly-owned Allstate Insurance Company and the National General Insurance Group.