Early in the coronavirus crisis, the Illinois State Medical
Society (ISMS) worked with the Pritzker Administration in taking decisive steps
to fight the pandemic. The governor ultimately issued executive orders to increase
the volunteer medical workforce and provide
temporary liability protection for healthcare delivery.
There was also a recognized need for a different type of healthcare, one that
allowed patients to receive healthcare in the safety of their own home. One solution
to this dilemma was, of course, telemedicine.
On March
19, 2020, the governor issued Executive Order 2020-09, which called for all
state-regulated insurance plans to cover telemedicine at rates equivalent to in-person
examinations. In addition, the Order called for elimination of prior
authorization requirements and elimination of most copays for telehealth
services. On the federal level, the
Trump Administration instituted similar flexibilities to facilitate the use of
telemedicine, ensuring broad Medicare coverage of telemedicine with payment
parity and relaxing some privacy-related regulatory barriers.
These
actions have transformed the delivery of healthcare. The growth of telemedicine
was reviewed in the July 28, 2020, Issue Brief from the Assistant Secretary for
Planning and Evaluation (ASPE). For the 38.5 million fee-for-service Medicare
beneficiaries, primary care visits by telemedicine constituted 0.1% of the
total for the week ending March 11; 45.9% by April 15; and 19.9% as of June 3. The
tremendous surge in the use of telehealth seems to have stabilized at levels
below the peak, but current levels are still far higher than the baseline pre-pandemic
levels.
Prior to
the pandemic, telehealth existed, but there was often significant resistance to
its use from physicians, patients, and especially insurance carriers. During
the pandemic, the previous technical and institutional barriers were considered
surmountable. Patients were scared to leave their homes; stay-at-home orders
were in place; and for many patients, telemedicine was the only way to access
care. Countless physicians immediately began to use telemedicine, in many cases
for more complex patients than had been so evaluated previously. This shift to
telemedicine represents a profound change in the thinking of both patients and
physicians, and has enormous potential to increase access to quality medical
care for every Illinoisan.
During the
early part of the crisis, ISMS surveyed 500 members about telemedicine, and the
results were enlightening. For ISMS members, the use of telemedicine increased
from 22% to 81% during the COVID crisis. A large majority of members who use
telemedicine (77%) wish to continue to do so, and physicians estimated that
telemedicine would account for about 30% of their practice in the future. In
the survey, members emphasized the benefits of telemedicine, including safety
for the patients and the ability to access care in a timely fashion.
This
expanded access to telemedicine coverage will continue throughout the course of
the public health emergency, but there is great speculation about the extended future
of telemedicine. On a federal level, Seema Verma, MPH, administrator of the
Centers for Medicare and Medicaid Services (CMS), made her opinion about
telemedicine clear: “Reversing course would be a mistake.” On the state level,
the top ISMS legislative priority during the COVID crisis has been to make the
policies initiated under the governor’s Executive Order permanent, in regards
to telemedicine coverage and payment parity. There has already been pushback
from the insurance industry, particularly on the issue of payment parity with
in-person exams. Telemedicine is an increasingly versatile tool in the
armamentarium of healthcare, and permanent legislative changes are needed to
assure continued access to this modality of care while continuing to provide
access to in-person care.
ISMS
was present at the beginning of this revolution in healthcare, and ISMS will continue
to represent physicians and patients to assure that telemedicine reforms are
made permanent. Telemedicine, which arose out of necessity, has already
transformed the delivery of healthcare for millions of Americans.
Robert W. Panton, MD
Send your questions and comments
to Dr. Panton.