Insights
Due to the coronavirus pandemic, many facilities have severely limited operations and moved face-to-face services to virtually enabled services. This has greatly expanded the use of telehealth during the pandemic. However, as many states begin resuming face-to-face healthcare services during phased reopening, it is important to consider what telehealth and support for telehealth will look like after the pandemic. The Centers for Medicare and Medicaid Services (CMS) has recently issued guidance to support medical facilities in the provision of non-emergent, non-covid-19 care. This new guidance does not negate previous changes to telehealth reimbursement, but rather, it promotes telehealth use in tandem with face-to-face care.
Even before the COVID-19 pandemic, CMS had been expanding coverage for telehealth services, including e-visits and virtual check-ins. Additionally, a recent survey found that over 50% of providers were using telehealth before the pandemic, up from only 18% in 2018.1 The federal government has been investing in the expansion of telehealth capabilities over the past few years. In addition to the CMS guidance, other agencies such as HRSA fund many projects and resources centers to promote telehealth. Furthermore, the FCC recently spent $3.7 million on five new projects that expand telehealth.2 As a result of the pandemic and increased support for telehealth services, many facilities have moved as many face-to-face services to virtual services as possible.
The CMS guidelines mirror the three phases of the Administration’s Guidelines for Opening Up America Again, applying to those states that are currently in Phase 1. It is important to note that Phase 1 is still very limited in its relaxation of daily activities. Additionally, vulnerable individuals must continue to shelter in place during this phase. This includes individuals in nursing homes, which are not permitted to allow visitors. Phase 1 includes the relaxation of the prohibition on non-urgent services, and it allows surgeries to resume on a limited basis. Despite the gradual reopening of face-to-face services, telehealth uptake is still expected to be high during this phase.
In Phase 2, more involved surgeries and services are expected to resume. However, visits to nursing homes and hospitals are still prohibited. In addition, large spaces are expected to continue operating under physical distancing guidelines. Since COVID-19 will continue to pose significant challenges during this period, telehealth uptake is expected to remain high, particularly for those who are part of vulnerable populations.
Due to the strict requirements that must be met before advancing between stages, it will most likely take some time before states reach Phase 3. Phase 3 means that states have no evidence of a rebound and can relax the restrictions of phases 1 and 2. In this phase, visits to nursing homes and hospitals can resume. In addition, states can begin relaxing the social distancing protocols for larger venues. As Phase 3 allows areas to get closer to a form of pre-pandemic normalcy, it is expected that more care will shift away from virtual care and back to face-to- face care.
As we move between phases and beyond, policymakers will have numerous issues to consider. One of these key issues is whether the expanded support for telehealth should remain. With a great deal of uncertainty remaining, it is possible that all, some, or none of the current provisions will be rolled back after the pandemic. In other words, while telehealth is an important tool to ensure that patients receive the care they need without needing to leave their homes, the future of it beyond the coronavirus pandemic remains to be seen.
Disclaimer: This piece was written by Saira Haque (Director, Data Interoperability and Clinical Informatics) and Adam Vincent (Research Health IT Scientist) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.