Use of telemedicine in the U.S. has been low to date. However, asexpected, it is expected that demand for these services will increase dramatically over the next few months because of the coronavirus (COVID-19) crisis, says GlobalData, a leading data and analytics company.
Telemedicine has been touted as a critical strategy during the COVID-19 emergency to limit the risk of person-to-person transmission of the virus, prevent emergency rooms from being inundated, reduce barriers to screening, and allowing those with moderate symptoms to be treated from home. Teladoc Health, a telehealth provider, announced that patient visit volume had increased by 50% since the previous week and was continuing to rise.
Kathryn Whitney, MSc, director of thematic analysis at GlobalData, said: “Prior to the COVID-19 crisis, telemedicine had never reached its full potential in the US, with several barriers preventing its widespread uptake. These include lack of reimbursement and restrictions affecting access for rural populations, general lack of awareness of these services, and the desire of the sick to see their physician in person.”
Since early March, regulations in the US governing the use of telemedicine have changed regularly, which will expand access to services during the COVID-19 emergency, particularly for Medicare beneficiaries who are deemed at high risk for the virus. In certain states, including California and New York, officials have also announced that payers must offer telehealth services as part of their emergency plans. In Massachusetts, payers must cover the COVID-19 testing and treatment via telehealth, and cannot impose cost sharing via co-pays, deductibles, or coinsurance, and prior authorization is not required to receive treatment via telehealth.
Whitney continues: “Recent changes to regulations by the U.S. government will remove many of the financial barriers to telehealth and drive the use of these services, particularly among older and vulnerable populations. People will also become more aware of these types of services, given amount of information being disseminated by the government, hospitals, healthcare systems and payers.
“As more U.S. cities and states begin to lock down and social distancing becomes the new normal for the foreseeable future, Americans are likely to change their views on telemedicine. With the ongoing risk of virus transmission, people will be eager to avoid hospitals and get screened and receive care from the safety of their own homes.”
By Dr. Jason Hallock, MD, chief medical officer, SOC Telemed.
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.
As COVID-19 continues to spread in the United States, health care providers are turning to technology to help treat patients who may be infected and also prevent the spread of the illness.
While there are no known cases of COVID-19 in Alabama, plans to use telehealth technology to fight the spread of the virus are already in place at the University of Alabama at Birmingham.
According to Eric Wallace, M.D., the medical director of UAB eMedicine, UAB is considering using telehealth through three approaches to help care for patients both in Birmingham and around the state.
Keep patients at home
The first approach is to keep as many patients who do not have upper respiratory symptoms at home, especially those who have weakened immune systems. The most common COVID-19 symptoms are fever, runny nose, dry cough, shortness of breath, fatigue and body aches.
“We plan to use telehealth technology to see as many patients in their homes as possible, especially those who are most at risk, such as the elderly and immunosuppressed patients,” Wallace said. “For example, if you have a urinary tract infection, the last thing you should do is go to the doctor’s office and wait in a waiting room when you could have had your UTI treated from home.”
If you have any of the COVID-19 symptoms, you should call your health care provider first before going to the doctor’s office. If you do not have any of the symptoms, but need medical care, Wallace recommends calling your doctor or using UAB’s eMedicine online service. The service allows doctors to diagnose and treat patients for a variety of common conditions online. Furthermore, UAB’s eMedicine online service is now serving as a location to help screen patients with COVID-19 symptoms to determine whether referral for in-person testing is necessary.
The American Medical Association (AMA) today announced that the CPT Editorial Panel approved a new addition to the Current Procedural Terminology (CPT) code set that will help streamline data-driven resource and allocation planning in the battle against the novel coronavirus (SARS-CoV-2) as the number of confirmed COVID-19 cases continues to rise in the United States.
“In the face of the COVID-19 pandemic, the CPT Editorial Panel has expedited approval of a unique CPT code to report laboratory testing services that diagnose the presence of the novel coronavirus,” said AMA President Patrice A. Harris, M.D., M.A. “The new CPT code assigned to the test for the novel coronavirus provides analytical advantages for tracking, allocating and optimizing resources as testing ramps up in the United States.”
For quick reference, the new Category I CPT code and long descriptor are:
87635 — Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
The code is effective immediately for use as the industry standard for reporting of tests for the novel coronavirus across the nation’s health care system. In addition to the long descriptor, CPT code 87635 has short and medium descriptors that can be accessed on the AMA website.
The CPT Editorial Panel, the independent body convened by the AMA with sole authority to manage revisions to the CPT code set, expedited the code development process for the novel coronavirus test. Development, review and approval of the new CPT code involved broad input from practicing physicians, the Centers for Disease Control and Prevention (CDC) and other experts.
The AMA continues to invest in resources that keep physicians informed of the CDC’s guidance and updates, including the recent launch of the AMA’s Physician’s Guide to COVID-19, a quick-start reference to help physicians and their practices prepare for the pandemic. This is an expanded, downloadable and shareable version of resources available on the AMA’s COVID-19 resource center for physicians. Additionally, the AMA’s JAMA Network™ has a comprehensive overview of the novel coronavirus—including epidemiology, infection control and prevention recommendations—available on its JN Learning website.
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.
“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