The HHS has directly asked states to remove barriers to interstate practice to accommodate telehealth visits across state lines. However, some states still require providers to have full licensure in their state to conduct telehealth visits or do not allow providers to render new diagnoses via telehealth, Dr. Phillips said. “We expect that once the crisis is over, prior licensure requirements probably will resume.”
CMS waivers for telehealth platforms that are not HIPAA-compliant may not continue after the pandemic, so practices should invest in at least one compliant telehealth platform if possible, and use platforms like FaceTime as a backup, said Dr. Phillips.
The day before a telehealth appointment, panelists suggested that a staff member should:
- Call the patient to check video compatibility and connections;
- Ask the patient to email photos of their joint in different positions;
- Prepare charts and medication lists; and
- Email the link to log onto the telehealth platform.
Safe Reopening
The ACR posted strategies to help rheumatology practices safely reopen for in-person visits, said Virginia Reddy, MD, a rheumatologist in Dallas. Ensure clinic waiting rooms allow for people to stand six feet apart, ask patients to check in from their cars and wait there until an exam room opens, and require masks or provide them at check-in. Her clinic removed chairs from the staff break room and emailed reminders to employees to stay home if they have possible COVID-19 symptoms or may have been exposed to infection. At her clinic, all staff must wear surgical masks and, when in close contact with patients, a face shield or goggles as well. Providers who are in exam rooms for prolonged periods wear N-95 masks.
Follow the CDC’s updated guidelines to guide staff on when to stay home, said Angus Worthing, MD, a rheumatologist in Washington, D.C. Symptom-based strategies may be more practical than test-based strategies due to limited testing availability or long delays in getting results, he said.
Social distancing tips for rheumatology clinics include:
- Ask patients to come alone to clinic appointments unless they require help, such as understanding the doctor’s recommendations;
- Limit time spent in the exam room in close contact and the number of people in these rooms. Trainees may examine patients without supervision and report their findings to the rheumatologist outside the room. Save any typing for after the exam; and
- Consider keeping the exam room door open and increase privacy with a curtain or a noise machine.
For adult patients who test positive for COVID-19, the ACR posted updated clinical guidance on when they may safely restart immunosuppressive therapy, said Dr. Worthing. Recommendations cover patients with both complicated and asymptomatic COVID-19 infections. Clinical guidance is also available for pediatric patients.
