RALEIGH — The coronavirus, by its very nature, is forcing regulators, insurers, and doctors to embrace telemedicine.
The Trump administration scrapped Medicare’s restrictions on telehealth, freeing doctors to treat seniors with telemedicine. The administration is pushing state Medicaid programs to track Medicare’s higher reimbursements for telehealth, and some private insurers are covering members’ telehealth for the COVID-19 pandemic.
Regulators’ scramble to mobilize telemedicine has doctors wondering if COVID-19 will cut the red tape that prevented them from treating patients. But we don’t know if these changes will push private insurers to boost their payments for telehealth, or if the new rules will stick around after the pandemic subsides.
“This is going to create a much-need paradigm shift in medicine,” said Dr. Kevin Campbell, cardiologist and chief medical officer of PaceMate, a national cardiac remote monitoring company. “COVID is a horrible situation, something our country has never faced and hopefully will never face again. But this is also an opportunity for us to rise to the occasion … or we’re going to see the devastation of our health care system.”
Before the announcement, Medicare regulations all but throttled telemedicine. Seniors couldn’t get telemedicine services in their home. They had to go to designated medical facilities — and only seniors who lived in rural areas qualified for Medicare telehealth coverage.
Until the COVID-19 outbreak, major private insurers mostly followed Medicare’s restrictions. North Carolina layered on its own patchwork of regulations, forbidding out-of-state providers from treating residents.
For doctors and nurses, those restrictions prevented them from using telemedicine to protect patients from the risk of getting exposed to COVID-19.
When the state’s outbreak was beginning, a patient with a cough, a fever, and a troubling travel history walked into nurse practitioner Lorretta’s clinic in eastern North Carolina. Her clinic didn’t yet have a protocol for COVID-19, and Lorretta made multiple calls to the state, asking about COVID-19 tests.
The patient had to wait in an exam room for more than two hours. The patient eventually tested negative, and the clinic has since started telehealth services.
“It was a nerve-racking few days there,” said Lorretta, who asked to be identified by her middle name to protect her job. “I hope telehealth is going to keep some of our most vulnerable patients outside the clinic, to decrease their risk.”
Insurance’s low telehealth reimbursements have long frustrated providers, who said they couldn’t afford to invest time in telemedicine.
Ten years ago, Dr. Gus Vickery still had time to make phone calls in his primary care practice. But as paperwork and regulatory burdens increased, he lost that ability. He says he doesn’t have time to take lunch breaks, much less make multiple phone calls.
“The cost of medicine requires you to saturate your schedule, all the time,” Vickery said. “The only way you can pay your staff, provide benefits, pay your lease, is to see people every 15 minutes. You don’t have the time for phone calls.”
That meant patients couldn’t access telemedicine.
“For a long time, many of the issues that people experience could have been solved by a short phone call,” Vickery said. “We knew we could often solve their problems with a phone call, but we didn’t have the time and resources to do it.”
Time and resources are now stretched to their limits, but the availability of telemedicine can be an efficient — and safe — path to care.
Nurse practitioner Schquthia Peacock has rolled out telemedicine in her practice in Cary. She’s used technology to see patients since mid-March, letting older patients stay at home, away from possible COVID-19 cases. The process hasn’t been without technological glitches, but she says the move is long overdue.
“This COVID-19 episode is kicking us into action. We’ve been stagnant,” Peacock said. “Why haven’t we started doing telemedicine before now? … We need to grow, and it’s kicked us into action. We can’t drag our feet anymore.”
In Charlotte, Dr. Dale Owen asked Tryon Medical Partners to prepare to transition to telehealth weeks ago. Nearly 90 physicians are now ready to switch entirely to telehealth, except for non-elective procedures.
“You could have heard a pin drop,” Owen said. “But I’m convinced this thing is going to be a ravage. I hope to be wrong, but if we are not prepared, the patients are going to suffer and we’re all going to get crushed.”
Providers hope telemedicine will slow the virus by protecting patients from exposure.
Even after the threat of the virus subsides, Vickery says, the changes will continue helping his patients.
“It’s going to be so much better for so many people,” Vickery said. “I’ll see people who are working factories, second shift, and they’re trying to come into our office, fight traffic, and they don’t have enough money to fill up their tank. If we can help those people get health care in a more efficient, affordable way, we should.”
But the state’s regulations against out-of-state telehealth providers still stand.
“Why make it difficult for physicians who are licensed and competent to provide care for North Carolinians?” Campbell said. “Make it easy and streamlined and allow for reciprocity of licensing.”
He hopes COVID-19 will spur regulators and physicians to take advantage of telemedicine.
“This virus has sparked change in us,” Peacock said. “We all won’t go back to what we were doing in the beginning of March. This is a different time.”