“This is important, as there is data from the FCC [Federal Communications Commission] that suggests that about 14 million Americans lack internet access and about 25 million lack broadband access,” Dr. Phillips said.5 Those numbers may be much higher, as industry data suggest that many people who live in cities still do not use the internet at broadband speeds, and many rheumatologists’ patients may not have access to adequate bandwidth for telehealth visits, he noted.6
Most states have temporarily relaxed cross-border licensure requirements for practicing interstate medicine via telehealth, and most telehealth restrictions on new patient appointments have been waived. However, some commercial plans that must meet minimum standards set by the Employee Retirement Income Security Act of 1974 may allow employers who offer the plans to opt out of telehealth coverage, he added. Updated information on states’ licensure requirements, CMS regulations for telehealth, billing codes, tips for navigating different platforms and other resources for rheumatology practices are available on the ACR website’s COVID-19 page.
Lower regulatory and financial barriers to implementation of telehealth may have helped rheumatology visits nationwide to rebound to 8% below the pre-COVID baseline by late July, mostly because telehealth filled the gaps, according to The Commonwealth Fund data.4 “I believe that many rheumatologists have taken up the mantle of telehealth and we are using it to serve our patients,” Dr. Phillips said.
Telehealth’s Potential Future
What happens after the pandemic hopefully ends? Many payers have arbitrary end dates on telehealth coverage, raising concerns from some ACR members, said Dr. Phillips. “But we’ve also seen those end dates pushed back as they become closer and the pandemic has not, unfortunately, ended. The big question is this: What will happen when the pandemic is over? Some of these relaxed restrictions may roll back.”
Dr. Phillips predicted that coverage for audio-only visits and relaxed restrictions on cross-state telehealthcare will roll back after the pandemic ends. Although CMS can adjust payment levels and the codes that it covers, the agency cannot, by law, permanently waive requirements that covered telehealth visits must be audio-visual or conducted at designed care sites. These changes must be made by Congress, he said. For now, he suggested that rheumatologists who practice telemedicine across state lines obtain permanent licenses and consider investing in HIPAA-compliant secure platforms and developing protocols to collect patient-reported outcomes through telehealth, if required by their states.
‘I believe that many rheumatologists have taken up the mantle of telehealth & we are using it to serve our patients.’ —Christopher Phillips, MD, FACR
In September 2020, ACR’s Committee on Rheumatologic Care issued a position statement on telehealth supporting audio-only and audio-visual visit payment parity, and protocols to protect patient data security while balancing the need for patient access, including a deeper look at HIPAA-compliant platforms, and proposals that facilitate cross-state practice of telemedicine.7 The ACR opposes restrictions on where patients may receive telehealthcare.
