By Dr. Jason Hallock, MD, chief medical officer, SOC Telemed.
Dr. Jason Hallock, MD
On March 13, President Trump declared the novel coronavirus (COVID-19) pandemic a national emergency. The declaration opens more than $42 billion in federal funding to combat the virus by expanding resources in key areas, including telehealth across the nation. While COVID-19 is novel there’s nothing new about telehealth solutions that are now moving to the forefront care in light of this virus.
Funding will support an increase in COVID-19 testing and expand telehealth services to virtually care for patients. HHS can waive licensing regulations to allow out-of-state physicians to treat patients via telehealth wherever outbreaks occur. And, critically, the declaration of emergency allows for $500 million in Medicare waivers for telehealth restrictions.
The action comes at a critical moment, as the U.S. health care system is confronted for the first time in its modern history with the possibility of a hospital capacity crisis. If too many COVID-19 positive cases descend on our hospitals at once, we could be in the unenviable position of lacking the onsite equipment, the beds, tests, staff and other resources to provide life-saving care for all. Such dark medical realities are already true elsewhere in the world.
As the contents of the national emergency declaration show, telemedicine is poised to play a key role in the fight against COVID-19. It’s not by accident.
While the virus spread rapidly to pandemic status, the reality is that the healthcare industry long anticipated the possibility of a fast-spreading global contagion. As we in the industry planned for the possibility of such an event, telemedicine was always among the solutions.
The role of telemedicine in the time of a pandemic is not an experiment or for use in a limited trial—it’s actively being used to treat COVID-19 today. In fact, the Centers for Disease Control and Prevention (CDC) continues to urge doctors and hospitals first to assess potentially infected patients remotely whenever possible, and to care for patients with mild COVID-19 symptoms from home using virtual check-ins.
The coronavirus is dangerous because of how easily it spreads from person to person. If you believe you have it or have been confirmed to have it through testing, then you will need to self-quarantine.
Self-quarantining is a precaution that everyone should aim to take if they have been in an infected area or are experiencing flu-like symptoms. Though the chances of you yourself dying or reaching a critical state are overall low, if you are infectious, you could pass the disease on to someone who is at risk. Those who are older or who have underlying health conditions are at risk of reaching a critical state if they catch the coronavirus. Quarantine yourself if you have a cold, take these precautions, and get better fast:
Try to Stay Away From Non-Infected Family Members
This can be difficult if you live in a small space, but if you can try to stay away from members of your family who aren’t sick as much as possible. This might mean further quarantining yourself to your room while testing is done or while you are sick. It might mean having your non-sick family member stay with a friend in the area instead. Go through your options to help reduce the risk of spreading the disease to others.
Order Food and Supplies to Your Door
When you are under self-quarantine, you won’t want to leave your home, even if it’s just to buy groceries. Thankfully there are many door-to-door options out there. Your grocery store might offer a delivery option, or you might have to go with a company like Uber Eats or Post Mates.
Do note that some companies have changed their policies in light of the coronavirus, so you might not see the delivery person, and instead have your order placed outside the door instead of handed to you.This also applies to supplies. There are many online retailers to help you bulk up, even for medical supplies like a finger bandage or medicine. Knowing how and where to shop for these items is going to be important when it comes to caring for and providing for your family under self-quarantine.
Catch the Cold
While you are sick, you will want to catch the cold, so to speak. Have tissues at the ready to cover your mouth or nose if you cough or sneeze. Immediately throw the tissue out and then wash your hands. This will help reduce the spread of the coronavirus in your own home.
The Centers for Medicare & Medicaid Services (CMS) issued a fact sheet with additional guidance for healthcare providers and patients about the telehealth benefits in the agency’s Medicare program. The fact sheet is part of a broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this disease.
“As we continue to learn about the COVID-19 virus, it’s important for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers when they feel sick or have questions” said CMS Administrator Seema Verma. “Over the last three years, President Trump’s leadership and historic efforts have made it possible for doctors to bill for their time on the phone or video chat with patients to help triage medical issues. Today, a patient who is not feeling well can call their doctor to decide whether or not they need to go in for a visit, offering solutions and peace of mind immediately.”
CMS’ historic effort made virtual check-ins and other services that use telecommunications possible with new policies implemented in 2019 and 2020. These services are available right now to patients and their physicians, providing a great deal of flexibility and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.
With the COVID-19 virus, there is an urgency to expand the use of virtual care to keep the beneficiaries with mild symptoms in their homes while increasing access to their provider’s office.
For the beneficiary, these benefits can be very helpful. For example, a Medicare beneficiary who is looking for advice about symptoms they are experiencing, can call their doctor and receive medical advice about whether he or she needs to see their doctor in person for a physical exam.
If they start to feel more ill, a virtual check-in allows a healthcare provider to offer recommendations about next steps and even take precautions for someone they are concerned may have the COVID-19 virus or flu before they step in the office or hospital putting others at risk. These check-ins are billable services and the Medicare coinsurance and deductible would apply to these services.
Medicare Advantage plans may also provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes, as part of their benefit packages for a plan year.
Therefore, enrollees in Medicare Advantage plans that include coverage of such services may be available to receive clinically appropriate services for treatment of COVID-19 via telehealth from many sites, including their home.
Rimidi, a cloud-based software platform, announced the launch of its patient-reported outcomes survey app to help limit the spread of COVID-19 in healthcare settings. Currently, the app is in expedited beta testing by select U.S. health systems operating in the regions at the greatest risk of Coronavirus outbreak. Rimidi anticipates general availability of the app before the end of March 2020.
Ide
“One of the greatest challenges in China and across other countries that faced early COVID-19 outbreaks has been hospital-based transmission,” said Lucienne Ide, MD, PhD, founder of Rimidi. “With the app, we can help keep potentially infectious individuals from exposing other patients or staff in the healthcare system in waiting rooms, emergency rooms, or triage before they are identified and separated.”
Combatting Coronavirus Spread via Advanced EHR-integrated Technology
Along with their text message appointment reminder, patients are sent a brief COVID-19 screening survey inquiring about current symptoms and recent travel. Integrated within the electronic health record (EHR), patient responses are easily captured and analyzed by clinical teams. The survey respondents demonstrating potential risk of COVID-19 exposure, in accordance with the latest CDC guidelines, are immediately notified with the appropriate next steps of care and treatment options, while the healthcare system is confidentially made aware of the at-risk patient.
Ultimately, the simplicity and accessibility of Rimidi’s screening app will help minimize the spread and impact of COVID-19 in healthcare settings by reducing the number of undiagnosed patients interacting with patients seeking standard care. It will also limit exposure of healthcare staff to potentially infectious patients in settings that are not adequately prepared.
Dr. Ide added, “The need for such a screening app was advocated for in a JAMA article following the Ebola outbreak in 2014. Today, the potential COVID-19 public health emergency reinforces the healthcare industry’s need for interoperability and stronger data-sharing rules to ease the flow of information, which enables rapid deployment of a single application across multiple EHR platforms.”
Rimidi remains in close coordination with the Centers for Disease Control and Prevention and will incorporate new evidence and its evolving guidance into the screening app as it emerges. This may include ongoing remote monitoring and self-reporting by patients in quarantine, among other features.
For more information and to be notified when the app is widely available for healthcare systems, please visit rimidi.com/covid19.
The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).
CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases.
In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.
“CMS continues to leverage every tool at our disposal in responding to COVID-19,” said CMS Administrator Seema Verma. “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”
HCPCS is a standardized coding system that Medicare and other health insurers use to submit claims for services provided to patients. Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus.
This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) announced today allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.
The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates.
Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.
To ensure the public has clear information on coverage and benefits under CMS programs, the agency also released three fact sheets that cover diagnostic laboratory tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies.
Medicare Fact Sheet Highlights: In addition to the diagnostic tests described above, Medicare covers all medically necessary hospitalizations, as well as brief “virtual check-ins,” which allows patients and their doctors to connect by phone or video chat.
Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights: Testing and diagnostic services are commonly covered services, and laboratory and x-ray services are a mandatory benefit covered and reimbursed in all states. States are required to provide both inpatient and outpatient hospital services to beneficiaries. All states provide coverage of hospital care for children and pregnant women enrolled in CHIP. Specific questions on covered benefits should be directed to the respective state Medicaid and CHIP agency.
Individual and Small Group Market Insurance Coverage: Existing federal rules governing health insurance coverage, including with respect to viral infections, apply to the diagnosis and treatment of with Coronavirus (COVID-19). This includes plans purchased through HealthCare.gov. Patients should contact their insurer to determine specific benefits and coverage policies. Benefit and coverage details may vary by state and by plan. States may choose to work with plans and issuers to determine the coverage and cost-sharing parameters for COVID-19 related diagnoses, treatments, equipment, telehealth and home health services, and other related costs.
Summary of CMS Public Health Action on COVID-19 to date:
On Mar. 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. For more information on CMS actions to prepare for and respond to COVID-19, visit: https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus
The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).