During the coronavirus pandemic, telemedicine appointments have increased dramatically to keep people away from hospitals and doctors’ offices. State and federal regulations have been relaxed to make these virtual visits more accessible than ever. Some question whether this new framework will be sustainable over the long term.
“Patients really like it, and we like the ease of being able to communicate with our patients, and now that everyone’s adjusting, I think it’s really nice," said Dr. Brittany Myers, a child and adolescent psychologist at MetroHealth.
Myers has had to meet with most of her patients via telehealth over the past few months due to COVID-19. She said telehealth appointments have been a mostly positive experience. She said patients and their families like not having to travel and pay for parking. Video calls allow her to see a patient in their home environment, which she said can feel very personal. There have some issues, she said, particularly due to the digital divide.
“Having access to computers, having access to reliable internet connections, having access to a phone that is able to connect, and downloading the app, and the literacy involved in that, I do think it’s been challenging," Myers said.
The solution for technical difficulties is often reconnecting on a backup video call method, such as FaceTime or Google Duo, or even resorting to a regular phone call. Communicating with patients through these informal platforms wasn’t previously allowed by HIPAA for privacy and security reasons, but now, these restrictions have been relaxed.
Dr. Matt Faiman of the Cleveland Clinic’s Express Care Online service said this change is only temporary.
“There will be a point when the federal government determines that we're not in an emergency situation anymore," he said. "Then, they will probably tighten up some of those relaxed rules.”
The Ohio Department of Medicaid has also adapted its policies to reflect the federal government’s new rules. Director Maureen Corcoran said virtual visits are reimbursed at the same rate as in-person ones, and this was expanded during the pandemic to also cover phone calls and approved video apps.
“We basically sort of said, under the circumstances, any kind of electronic communication will be acceptable," Corcoran said. "All with this idea of making it as fully accessible and financially equal.”
Corcoran said going forward, some privacy restrictions should be tightened while still keeping some of the relaxed rules.
“Being able to take full advantage of cellphones would be a goal. Particularly given when you think about younger people who are very accustomed to cellphones and different kinds of apps on cellphones," she said. "None of that has the degree of security that is typically required.”
Faiman agreed, and said insurance issues need to be considered as well. He said some commercial insurance companies don’t pay, or pay less, for telehealth visits, which has been a hassle for both patients and healthcare providers to navigate.
“It definitely has been a bother that they will pay a slightly reduced rate, and then another insurance company says, ‘oh, we’ll pay exactly the same as in person,'" he said. "Consistently inconsistent. It makes for headaches because you have to navigate all of these landmines."
Faiman said for telehealth to be sustainable, it needs to stay accessible.
“My hope would be that the barriers that we have now had to be forced to look at, and they've been relaxed, that those won't be completely tightened back up to where they were before, so that all healthcare could deliver and optimize itself so that now in the future, a third, or something like that, of visits could be delivered virtually.”
Myers said she’d like to see telehealth’s prevalence remain even after the pandemic is over.
“On the policy end, as doors are being opened to allow more telehealth, I would hope that they wouldn’t then close after all of this because we’re seeing that it’s really useful for patients, and it’s really nice to be able to provide the service," she said.
The new HIPAA regulations for telehealth are set to expire at the end of July.
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