Doctor holding tablet device

06.30.20

Telemedicine Beyond COVID-19

BY , , Sarah E. Swank

COVID-19 has accelerated the adoption of telemedicine. After navigating the initial legal risks of implementation, providers now see that telemedicine is sustainable and will be an integral part of their practices. In a recent webinar, Kate Woods, Chief Compliance Officer & SVP Human Resources, Schweiger Dermatology, shared insight into the telemedicine implementation experience. 

Before COVID-19, physician adoption of telemedicine was somewhat limited due to legal barriers such as state licensure restrictions, limited reimbursement, and fraud and abuse compliance concerns. For example, Medicare reimbursement for telemedicine was limited to rural areas and designated types of “originating” and “distant” sites. Others found providing telemedicine services only to commercial payors and direct to employers the only viable model to avoid these concerns. Prescribing laws often required that the first visit be in person prior to prescribing certain drugs.

In addition, telemedicine was not always embraced across specialties or care settings. Some physicians held on to traditional models of care believing that patients needed to be seen in person and that virtual visits got in the way of a patient-physician relationship. As the pandemic hit, many physicians across the country were required to close physical offices due to concerns about COVID-19 exposure and limited PPE supplies. These physicians pivoted quickly toward telemedicine to care for their patients.

Centers for Medicare & Medicaid Services (CMS) waivers and Office for Civil Rights (OCR) enforcement discretion for technology platforms allowed physicians the ability to get up to speed immediately, especially across state lines. These telemedicine waivers opened the door for Medicaid and commercial payors to pay for telemedicine visits at the same rate as an in office physician visit. In addition, physician licensure requirements are often tied to governor executive orders, which can end for different states at different times, and create a patchwork of compliance concerns for those who practice across state lines or whose patients left their geographic areas for other states because of the pandemic.

Future Challenge of Telemedicine Post-COVID-19

We expect (due to physician and patient experience and the ongoing nature of this public health emergency) to see some of the same telemedicine changes during the pandemic formalized into federal and state laws and regulations. It is unclear whether reimbursement models and licensure waivers will eventually end. While we expect that states will continue to require processes for in-state clinician licensing, the movement of patients during the pandemic, as well as patients’ desire to receive treatment from their clinician wherever they may be located, could pressure some states to make the licensure process more streamlined for clinicians licensed in other states.

The major issues that will impact future telemedicine practices will include Medicare reimbursement issues, availability and development of HIPAA-compliant technology platforms, fraud and abuse compliance, and state licensure rules. Since waivers and COVID-19 guidelines are temporary, health care businesses should build out the proper infrastructure and operations now around a compliance-oriented model. This way, practices will more likely be ready to carry on telemedicine practices post-pandemic.

 

 

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Michele A. Masucci

Partner

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Valerie Breslin Montague

Partner

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Sarah E. Swank

Counsel

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