In general, we need to consider the possibility that this crisis may lead to a winter or even a mini-ice age, in which the economic impact may last several years, as opposed to a blizzard that we can weather and clean up from in a few months.3 Until there is sufficient herd immunity, an effective vaccine or both, we should expect viral circulation that may lead to ongoing regional outbreaks, leading in turn to regional re-introduction of distancing protocols, even after initial restrictions are lifted.
Mitigating Losses & Planning for Post-COVID Remote Care
What factors may impact current practice health and what lingering impacts may ACR member practices see when the COVID-19 crisis abates? The ability to continue providing evaluation and management (E/M) services through the crisis is critical.
Many of us have learned telehealth on the fly. We all have frustrating stories, which usually revolve around poor internet connections or dropped calls. However, I suspect many of us, if we are honest, would admit we have learned this skill more easily than we imagined.
We have the aid of the Centers for Medicare & Medicaid Services (CMS), which is reimbursing for audiovisual telehealth visits conducted with the patient in their home, across state lines and even with non-HIPAA-compliant modalities.4 (How many iPhone users have fallen back on FaceTime when the default platform failed? I am guilty as charged.)
Fortunately, most commercial payers have followed suit and are paying for these services at office visit rates. The ACR and other groups have advocated coverage for audio-only encounters at standard E/M rates during the current crisis, because so many of our patients lack internet connectivity to support a video feed. Just as I finalized this document, word came that CMS has listened and is providing audio-only payment parity. (Reminder: Advocacy works!)
The U.S. Department of Health & Human Services (HHS) has given guidance to states suggesting they eliminate barriers to interstate telehealth services.5,6 However, state regulations remain a patchwork quilt, with some allowing carte blanche interstate care, some denying it and others requiring emergency licensure.7
Getting a taste of telehealth, some of our patients like it. When this crisis is over, be prepared for some patients to continue to request remote service. Will it be available to them? If CMS and commercial payers continue to reimburse telehealth at standard E/M rates and allow patients to be seen from their home, expect telehealth to remain popular.8
