In the first three months of the COVID-19 pandemic, half of the 1,800 U.S. patients surveyed by Doctor.com reported using telemedicine to access care.1 Rheumatology providers are using telemedicine to maintain patient care today, while looking at the future potential of telemedicine to address workforce shortages and improve patient access to care.
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However, telemedicine does present unique requirements for care coordination and billing practices.2 The ACR has released a Telemedicine Position Statement to help rheumatologists operationalize telemedicine and sustain it as a viable business model in collaboration with regulatory rules and payer coding through the pandemic and beyond.
“The rapid expansion of telemedicine in rheumatology, largely brought about by changes to reimbursement and relaxed regulations during the COVID-19 pandemic, served as an impetus for rheumatologists and rheumatology health professionals to look more closely at the issues surrounding telemedicine,” notes Colin Edgerton, MD, FACP, RhMSUS, chair of the ACR’s Committee on Rheumatologic Care (CORC) and co-author of the statement. “There are clear benefits of telehealth and issues that need ongoing research. The ACR recognized these needs and responded with the position statement.”
Maintaining the Patient-Provider Connection
Statement co-author Arundathi Jayatilleke, MD, describes the new Telemedicine Position Statement as a tool that can to support patient access to rheumatology care by emphasizing the importance of the patient-provider relationship.
The ACR’s Telemedicine Position Statement includes eight formal positions that address a range of factors associated with telemedicine services. These include:
- The provider-patient relationship should include both in-person and telemedicine services;
- Telemedicine patients should be able to choose their providers;
- The scope of care provided via telemedicine services should be consistent with related in-person services; and
- Telemedicine services must be properly documented.
“Our dependence on telehealth during this pandemic has given us an opportunity to examine its benefits and limits in real-world rheumatology practice,” Dr. Jayatilleke says. She is a member of the CORC and directs the Rheumatology Fellowship Program at Temple University Hospital, Philadelphia.
Some of the limitations she sees rheumatologists and patients facing during the COVID-19 emergency include distance from providers, difficulties of safe in-person visits, patient unfamiliarity with platforms, lack of access to technology and internet services, and reimbursement to providers for telemedicine services. Dr. Jayatilleke hopes this position statement will serve as a foundation for rheumatologists to address these challenges and provide continuous high-quality care to their patients “whose illnesses do not stop even if they cannot come to the office.”
She also looks forward to research exploring the role of telemedicine and where it best fits into practice, which would potentially include changing models for education of rheumatology fellows.
As noted in the statement, telemedicine should not replace essential face-to-face assessments conducted at medically appropriate intervals. Dr. Edgerton says it will be critical, moving forward, for rheumatology teams to integrate telehealth into the traditional in-person evaluation and management paradigm, ensuring that a comprehensive understanding of the patient and their needs continues to inform decision making.
Recommending Reimbursement Guidance
The position statement also includes an in-depth discussion of key issues associated with implementing telemedicine now and in the long term, including recommendations that address federal, state and regulatory structures, which have obstructed rheumatology telemedicine services in the past.
Changes during the current public health emergency have relaxed restrictions and allowed practices and providers to continue to provide care. Such changes include reimbursement for telemedicine services to allow 1:1 parity with in-person visits for both audio-only and audiovisual visits, as well as relaxation of HIPAA (Health Insurance Portability and Accountability Act) regulations to allow patients and providers to use more familiar or user-friendly platforms.
“While telemedicine’s rapid uptake has occurred due to necessity during the pandemic, we recognize it is likely here to stay, and the regulatory boundaries that are in place after the current public health emergency is over will dictate how useful this modality is to members and patients,” says Chris Phillips, MD, also a co-author of the position statement and chair of the CORC Insurance Subcommittee.
“We do advocate for ongoing audiovisual and audio-only parity. This is currently offered by CMS [the Centers for Medicare & Medicaid Services] and by most commercial payers and we would like to see it persist,” Dr. Phillips shares. However, telemedicine coding varies by payer. To address this challenge for providers and ease their administrative burden, the Telemedicine Position Statement recommends that private payers follow coding guidelines from the CMS.
“Through advocating for fair reimbursement, favorable regulatory guardrails, and outcomes-based research for telemedicine, we are promoting an environment that would allow rheumatologists and rheumatology health professionals to have access to telemedicine as a tool for patient care, going forward, that benefits both the provider and the patient,” Dr. Phillips says.
The Telemedicine Position Statement reflects broad input from members of the CORC, Government Affairs Committee and the ACR’s board of directors. The position statement will also be shared with members of Congress, insurance carriers, private insurers and state insurance commissioners.
Carina Stanton is a freelance science journalist based in Denver.
- Telemedicine today: Patient adoption and preferences during COVID-19 and beyond. Doctor.com. https://www.doctor.com/blog/telemedicine-today-patient-adoption.
- ACR Telehealth Provider Fact Sheet. https://www.rheumatology.org/Portals/0/Files/acr-telemedicine-fact-sheet-2020.pdf.