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Telemedicine: A Versatile Tool for Increasing Access to Care During COVID-19 and Beyond

Early in the coronavirus crisis, the Illinois State Medical Society (ISMS) worked with the Pritzker Administration in taking decisive steps to fight the pandemic. The governor ultimately issued executive orders to increase the volunteer medical workforce and provide temporary liability protection for healthcare delivery. There was also a recognized need for a different type of healthcare, one that allowed patients to receive healthcare in the safety of their own home. One solution to this dilemma was, of course, telemedicine.

On March 19, 2020, the governor issued Executive Order 2020-09, which called for all state-regulated insurance plans to cover telemedicine at rates equivalent to in-person examinations. In addition, the Order called for elimination of prior authorization requirements and elimination of most copays for telehealth services.  On the federal level, the Trump Administration instituted similar flexibilities to facilitate the use of telemedicine, ensuring broad Medicare coverage of telemedicine with payment parity and relaxing some privacy-related regulatory barriers.

These actions have transformed the delivery of healthcare. The growth of telemedicine was reviewed in the July 28, 2020, Issue Brief from the Assistant Secretary for Planning and Evaluation (ASPE). For the 38.5 million fee-for-service Medicare beneficiaries, primary care visits by telemedicine constituted 0.1% of the total for the week ending March 11; 45.9% by April 15; and 19.9% as of June 3. The tremendous surge in the use of telehealth seems to have stabilized at levels below the peak, but current levels are still far higher than the baseline pre-pandemic levels.

Prior to the pandemic, telehealth existed, but there was often significant resistance to its use from physicians, patients, and especially insurance carriers. During the pandemic, the previous technical and institutional barriers were considered surmountable. Patients were scared to leave their homes; stay-at-home orders were in place; and for many patients, telemedicine was the only way to access care. Countless physicians immediately began to use telemedicine, in many cases for more complex patients than had been so evaluated previously. This shift to telemedicine represents a profound change in the thinking of both patients and physicians, and has enormous potential to increase access to quality medical care for every Illinoisan.

During the early part of the crisis, ISMS surveyed 500 members about telemedicine, and the results were enlightening. For ISMS members, the use of telemedicine increased from 22% to 81% during the COVID crisis. A large majority of members who use telemedicine (77%) wish to continue to do so, and physicians estimated that telemedicine would account for about 30% of their practice in the future. In the survey, members emphasized the benefits of telemedicine, including safety for the patients and the ability to access care in a timely fashion. 

This expanded access to telemedicine coverage will continue throughout the course of the public health emergency, but there is great speculation about the extended future of telemedicine. On a federal level, Seema Verma, MPH, administrator of the Centers for Medicare and Medicaid Services (CMS), made her opinion about telemedicine clear: “Reversing course would be a mistake.” On the state level, the top ISMS legislative priority during the COVID crisis has been to make the policies initiated under the governor’s Executive Order permanent, in regards to telemedicine coverage and payment parity. There has already been pushback from the insurance industry, particularly on the issue of payment parity with in-person exams. Telemedicine is an increasingly versatile tool in the armamentarium of healthcare, and permanent legislative changes are needed to assure continued access to this modality of care while continuing to provide access to in-person care.

ISMS was present at the beginning of this revolution in healthcare, and ISMS will continue to represent physicians and patients to assure that telemedicine reforms are made permanent. Telemedicine, which arose out of necessity, has already transformed the delivery of healthcare for millions of Americans.

Robert W. Panton, MD

 

Send your questions and comments to Dr. Panton.



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