In light of the current pandemic, everyday life for Americans across the country has been looking significantly different than anyone is used to. Whether we like it or not, life is going digital, at least for the next few weeks. People are being forced to work remotely, take their classes online through platforms such as Zoom, and many are even self-quarantining for two weeks. Medicine is also utilizing digital platforms, too. Telemedicine, defined by WHO as “healing at a distance”, has faced substantial obstacles to being fully implemented across the board.[i] Telehealth is the industry in which practitioners can offer health-related services including prescribing controlled substances via telecommunication using platforms like Google Hangouts and FaceTime. Projected to be a $17.8 billion industry by 2025, telehealth has gained significant traction in recent years to improve the ease and accessibility of care. [ii] However, many issues are still present regarding telehealth including reduced care continuity, issues regarding reimbursement policies and privacy issues. [iii]On Tuesday, March 17th, the Trump Administration announced that they would be expanding coverage for Medicare users during this outbreak, as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act.[iv] American patients and healthcare professionals, however, still must ask what this means for healthcare both during the outbreak and in the future.
Covid–19 has been identified as most dangerous for two groups – the elderly and those with underlying health conditions.[v] Urgent care clinics and emergency rooms across the nation have been inundated with patients coming in for cold and flu symptoms, afraid they may have the deadly virus. Healthcare professionals are being overwhelmed by the sheer number of people coming in, a large proportion of which would not otherwise come in with common cold symptoms aside from fear of Covid-19. A big concern, however, is how this inundation of the health system by people with cold and flu symptoms, is becoming a barrier for people with other serious conditions to be able to receive care. Those with conditions such as diabetes, or with chronic heart or lung disease, may be severely disincentivized from visiting the doctor during the current pandemic, even when they need care. Although those who are in dire need of urgent care will probably heed caution and still go into the doctor, the biggest problem is for those with those conditions who need their routine checkups or may need new medication prescriptions, but are in fear or contracting Covid-19 if they go in. This is where telemedicine comes into play.
Prior to this outbreak, the biggest concerns surrounding telemedicine have been regarding faulty reimbursement policies that disincentivize healthcare facilities from providing telehealth.[vi] Private and public insurers often reimburse telemedicine visits at lower rates than in-person visits, so it only makes sense that providers would want to minimize the number of telecommunicated visits. [vii]Yesterday, in the briefing, Seema Varma announced that telehealth coverage would be extended to people everywhere, not just in rural areas, at standard copays that patients pay for in-patient visits. Additionally, Humana and Aetna have expanded their telemedicine coverage as a response to the outbreak.[viii] Aetna is covering telemedicine visits for any reason without copays and Humana is waiving costs for telemedicine urgent care visits for 90 days. This should aid in the expansion of telehealth availability. Another central concern is privacy issues, but these were also addressed in the briefing, as Varma announced HIPAA regulations will be relaxed during the outbreak. The Ryan Haight Act of 2008 specified that in order for practitioners to prescribe controlled substances via telemedicine, they would have to conduct an in-person consultation first.[ix] This act has been a significant barrier toward full telehealth benefits, but since the relaxation of this act by the DEA during the outbreak, people with serious conditions do not have to go in for an in-person consultation to receive the medicine they need.[x] People with chronic conditions can receive the medication they need and avoid excessive in-person exposure.
Big tech company executives from Facebook, Google, Amazon and Microsoft met with White House officials on March 15th, to discuss possible ways to further advance the telecommunication sector.[xi] Despite moves to expand telehealth availability, concerns regarding public awareness of telehealth opportunities are also present. If people do not realize they can receive care via telemedicine platforms, they may further jeopardize their health by going into urgent care clinics where they will be susceptible to serious health risks, such as Covid-19. Therefore, even if telemedicine is made more available, efforts need to be made to raise public awareness of that availability. “Healing at a distance” is incredibly vital in the current worldwide situation and is the perfect way to take social distancing to the medical arena. It may be one of our biggest weapons going forward in protecting the most vulnerable populations from serious illness.
[i] https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
[ii] https://www.openpr.com/news/1922009/telehealth-market-is-valued-at-expected-to-reach-usd-17-8-billion
[iii] https://evisit.com/resources/10-pros-and-cons-of-telemedicine/
[iv] https://www.usnews.com/news/health-news/articles/2020-03-17/to-keep-seniors-safe-at-home-medicare-expands-telemedicine
[v] https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html
[vi] https://healthtechmagazine.net/article/2019/08/fact-or-fallacy-telehealth-here-stay
[vii] Id.
[viii] https://www.kff.org/womens-health-policy/issue-brief/novel-coronavirus-covid-19-special-considerations-for-pregnant-women/?utm_campaign=KFF-2020-Womens-Health-Policy-WHP&utm_medium=email&_hsenc=p2ANqtz-_svKD6RRpfT-9w13CRwIdfvu6RQSlUUCyAwdaEZx2AMHSIWfljbGd05DB4h4AAl6eimYtPYehxoL_VB5VkTn6yPLcv_2ku37s3akItkAGo583O6s8&_hsmi=84864668&utm_source=hs_email&utm_content=84864668&hsCtaTracking=ec831e24-4f5f-48a0-abb1-67d984f99ab2%7C4912c198-834b-4447-9742-f546909a2711
[ix]https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/ryan-haight-act
[x] https://mhealthintelligence.com/news/warner-tells-dea-to-launch-registration-for-telehealth-prescriptions
[xi] https://www.wsj.com/articles/silicon-valley-ramps-up-efforts-to-tackle-virus-11584313224
Policy Interns 