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Has COVID-19 Created Permanent Changes in Telemedicine?

By Dr. Stacey Malinowski
Assistant Dean, School of Health Sciences

Spurned by the Centers for Disease Control and Prevention (CDC) guidance at the beginning of the COVID-19 pandemic, the United States has seen a rapid shift to the utilization of telemedicine. This form of healthcare has enabled real-time, interactive communication between a patient at home and a healthcare provider at a different site.

Early in the pandemic — from January to March 2020 — telemedicine visits were up 50% from the same time frame in 2019. In addition, there was a 154% increase in telemedicine usage noted in the 12th week of 2020, according to the CDC.

The CARES Act Removed Several Barriers to Telemedicine and Provided Aid in Other Areas

The U.S. Coronavirus Aid, Relief, and Economic Security (CARES) Act that was enacted on March 27, 2020, removed several barriers to telemedicine that previously existed. These obstacles included limited provider payments, regulations affecting state boundaries, and limitations placed on federally qualified health centers and rural health clinics. The CARES Act expanded the telemedicine benefit to 61.2 million Medicare recipients as of 2019.

This Medicare population is the same group who is deemed at highest risk by the CDC for severe illness related to COVID-19. For instance, eight out of 10 COVID-19 deaths reported in the U.S. come from the 65 and older age group. Between mid-March and mid-August of 2020, 12.1 million Medicare beneficiaries (36%) have utilized telemedicine.

The government has also provided additional funding for states that wish to expand their Medicaid programs to include telemedicine services. Between March and June of 2020, there were more than 34.5 million services delivered in a remote format to both Medicaid and Children’s Health Insurance Program (CHIP) recipients, a 2,600% increase over the same time period in 2019.

The CARES Act expands remote access not only to medical doctors, but also to nurse practitioners, physician assistants, nurse-midwives, certified nurse anesthetists, registered dieticians, nutrition professionals, clinical psychologists and licensed clinical social workers. This increased access permits a more holistic approach to maintaining health and wellness during a time of great crisis in our nation.

The Benefits of Telemedicine

The benefits of telemedicine during the pandemic cannot be understated. They include the conservation of personal protective equipment and reduced potential exposure to disease for both patients and providers. Other benefits involve expanded access to care for chronic disease management, urgent health needs and medication management.

But telemedicine is certainly not for everyone. While telemedicine can be conducted over a traditional landline, some patients do not have access to advanced technology for video visits or simply miss the in-person interaction with a healthcare provider.

Also, more distractions are prevalent in homes — doorbells ringing, children interrupting and less-than-stellar internet connections. For instance, 34 million Americans lack access to adequate broadband, and 40% of that population lives in rural areas.

Maintaining Patient Privacy and HIPAA Standards

One of the most frequent concerns about the use of telemedicine is patient privacy and potential violations of the Health Insurance Portability and Accountability Act (HIPAA). During the pandemic, healthcare providers that “serve patients in good faith” through everyday forms of telecommunications during the COVID-19 emergency may have any penalties waived for HIPAA violations. This waiver includes the use of software such as Skype or FaceTime for virtual “office visits.”

What Will Happen to Telemedicine When the COVID-19 Pandemic and CARES Act End?

So how will telemedicine trend when the pandemic is over? When the CARES Act ends, will providers continue to be reimbursed for telemedicine visits? Will some patients determine that is a more convenient way to see the doctor? Could virtual visits be an answer to the overcrowding and inappropriate utilization of emergency rooms across America that we saw pre-pandemic? Could using video technology be a way to increase compliance in traditionally “non-compliant” patients with chronic health conditions?

Professional healthcare organizations, such as the American Hospital Association and the American Academy of Family Physicians have been calling for government reform to enhance access to telemedicine since pre-pandemic days. Bills are repeatedly introduced by policymakers, but there was little progress made pre-pandemic. Perhaps a silver lining to COVID-19 is that it has demonstrated that there is an effective method for providing safe, affordable and equitable care that can close the existing gap in health disparities in America.

Dr. Stacey (Kram) Malinowski, DNP, RN, NPD-BC, CCRN-K, PCCN-K, CNE, is the Assistant Dean and Chief Nursing Administrator. Dr. Malinowski completed her Doctor of Nursing Practice at Salisbury University and has 20 years of nursing experience, primarily in the care of critically ill adults and their families. Prior to joining the university, Dr. Malinowski worked as a Nurse Manager for a novice nurse residency program within a community hospital system on the Eastern Shore of Maryland. She also served in the Army Reserve Nurse Corps for three years as a First Lieutenant with the 2290th USAH at Walter Reed Army Medical Center.

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