When, or if, we return to normal, recognize that some of the current emergency leniencies in telehealth regulation (i.e., HIPAA restrictions) may also revert to normal. Are you currently seeing patients across state lines due to the emergency regulations? Consider obtaining licensure in those states for future care. (Some states require full licensure; some states offer telehealth licenses; some states have reciprocity agreements for telehealth.)9
What about the ability to offer telehealth services after hours or on weekends? If you’re independent, entrepreneurial and/or looking to make up lost revenue, this option could sound great. If you are employed with a family at home and your employer sees this as a way for you to make up lost revenue, this option may not sound so great.
If you routinely provide uncompensated care via a patient portal (answering unsolicited patient questions not associated with an encounter in the previous seven days or the next 24 hours), the service may qualify for reimbursement as an e-visit.4
Could increased use of remote care dovetail with care coordination protocols we see as part of value-based care initiatives? Will this crisis propel us further down a value-based care pathway, and if so, how may our members best position themselves in contract negotiations?
What about the physical exam? One of the joys of rheumatology is that the physical exam still matters. Don’t we take pride in palpating synovitis the referring provider could not appreciate? How much of our diagnostic acumen is lost in an audiovisual meeting? Members will have different opinions on this matter, and we may find over time that certain circumstances are better suited for telehealth than others. A policy requiring in-person evaluation at least every other visit may be appropriate, for example.
I look forward to seeing research regarding best practices in rheumatology telehealth diagnostics in the next few years.
Concerns about Immune Suppression
What about our patients on biologics, and specifically infusions, during this difficult time? These patients are between a rock and a hard place, knowing their treatment may somewhat increase their risk for infection, but also knowing that stopping treatment may lead to disease flares, immune dysregulation and the need for steroids, which may be equally troublesome when considering COVID-19 complication risks.
The ACR has published guidance for safe infusion practices during COVID-19.10 Local COVID-19 prevalence, patient-specific risk factors and patient-specific disease features may guide decisions regarding treating or delaying. Practices continuing to infuse should be sure to consistently confirm that insurance coverage is active at the time of service in light of the economic situation. Some insurers may try to hijack the COVID-19 crisis as an excuse to move patients onto home infusions or other treatments that are preferred by the insurer but may not be in the patient’s best interest. We need to advocate for our patients, regardless of what treatment they are on, rather than let insurers dictate terms of treatment to us, couched in concern about patient safety during the pandemic.11
