The coronavirus pandemic is prompting a surge in telemedicine use, and advocates hope recent emergency expansions will mark a turning point in the movement toward virtual care.
As the world continues the new “social distancing” protocol, hospitals are working to reduce in-person contact to slow new infections and conserve resources for the critically ill. The pandemic is triggering a surge in telehealth adoption as U.S. doctors connect to patients virtually, with both established platforms and start-ups reporting astronomical increases in volume.
The Centers for Medicare and Medicaid Services temporarily relaxed restrictions on various audio-visual technologies, but providers are calling for additional clarity on state licensing provisions for clinicians, as well as technical limits around modalities like virtual chats.
Major telehealth providers are experiencing a coronavirus surge in volume in addition to the seasonal increase for cold and flu visits. MDLIVE said urgent care visits doubled in Washington state, one of the areas hit hardest by the outbreak. American Well, the producer of the Amwell app that has struggled with the influx in certain areas, said usage has increased 158 percent nationwide and 650 percent in Washington state.
American Well Chief Medical Officer Peter Antall said the company is speeding the installation of new servers and routers to handle the “unprecedented” circumstances facing the health care industry.
“We are working tirelessly and in close coordination with our clients to ensure our systems and personnel are able to handle the load,” he said in a statement.
Start-ups are also lending a hand. New York-based consumer telehealth platform Ro launched a free COVID-19 triage service to assess symptoms and potentially provide video consultations for anyone throughout the country.
Mark Stephan, chief medical officer for Q Point Health, part of the Phoenix-based consultant and tech provider Equality Health that partners with local physician practices, started rolling out a new video chat platform to 1,300 of its primary care doctors last week at no additional charge. Doctors began calling for general coronavirus information when the outbreak began, he said, but quickly started seeking help to limit the potential impact of the virus.
“The No. 1 ask was, ‘Do you have any recommendations for a telehealth solution?’” Stephan said.
The company is onboarding multiple practices a day, Stephan said, with representatives demonstrating both technical know-how and video basics such as lighting tips.
Privia Health, a similar Virginia-based technology and solutions company, said the number of telehealth visits on a recent Monday was on par with the entire month of January. The rate is increasing around 25 percent each day.
“It’s obviously exploded,” CEO Shawn Morris said.
CMS is offering state waivers to relax requirements limiting Medicare payments to rural patients receiving telehealth services at a facility, which would let Medicare pay for certain types of visits from a patient’s home regardless of the geographic region. CMS also said it would not audit providers to see if they had an established relationship with the patient beforehand, as is required in certain circumstances.
Increasing access to the Medicare population is important considering how vulnerable seniors are to the virus.
But telehealth expansions in federal programs are more incremental than IT advocates prefer. Medicare only pays for audio, visual or patient portal communications under certain circumstances.
Brendan Levy, executive medical director for GoodRx — which owns direct-to-consumer telehealth app HeyDoctor — said clarification around modalities like chat features are still needed. HeyDoctor typically services patients seeking quick prescriptions for things like birth control, although Levy said the company has been triaging hundreds of patients per day for COVID-19.
"Clear national guidelines that allow providers to decide the best modality of care (in-person, video, chat, etc.) for their patients would dramatically enhance our ability to treat many more people," he said.
A patchwork of state rules also makes it unclear where clinicians are allowed to practice. Vice President Mike Pence last week announced that the Department of Health and Human Services would be issuing regulations that day to allow doctors to practice across state lines, but HHS has so far not provided further details.
States mostly control their own licensing policies, and can strike agreements with each other to let physicians traverse their borders. It’s also unclear whether the Trump administration’s announcement would apply to telemedicine.
“The state licensure issue is certainly confusing,” Antall said. “We’re encouraged by the president’s announcement regarding the easing of state licensure restrictions, as this is something we’ve long been a proponent of, but the reality is this is not a federal issue and still must be enacted by each individual state.”
Even if the telehealth surge is temporary, advocates say a broader recognition of the technology’s benefits in times of crisis might be the slim silver lining to the pandemic. Ramping up virtual capabilities and increasing access and awareness could better prepare the country for the next infectious disease outbreak, and that recognition could help reduce restrictions on telehealth adoption.
“I think the medical community tends to be innovative if the reins are loosened,” Stephan said.