COVID-19 and telehealth revolution policy barriers are standing in the way of transforming care

telehealth, telemedicine, video calls with doctors, therapy, phone calls with therapist
The COVID-19 pandemic has unexpectedly catalyzed a transformational change in American health care. As millions of us sheltered-in-place, we found a way to “visit” the doctor without visiting the doctor.

Telehealth had already been proven safe and reliable, but policy barriers and reticence from patients and providers had prevented widespread use. It took a pandemic to mitigate these roadblocks and reveal how large-scale telehealth programs could help us achieve our elusive goals of improved health and cost-efficiency.

In a single stroke of the pen, In a single stroke of the pen, the federal National Emergency declaration wiped away barriers and created an unprecedented opportunity to change America’s health care system.

At Nemours Children’s Health System, we caught a glimpse of what this could mean to the 480,000 children for whom we care for across five states, two hospitals and 80 clinical sites. When our telehealth program, Nemours CareConnect, was launched in 2015, it was hampered by institutional barriers of cross-state licensure requirements and inconsistent reimbursement. This created significant challenges in scaling and operationalizing telehealth to induce its widespread use. 

COVID-19 changed all that. In a few weeks, the average daily use of telehealth appointments increased by 2200 percent, resulting in an average of 1,500 visits per day. We trained an additional 627 providers, bringing our total to 819 experts in primary, and specialty care in 53 specialties. Patient satisfaction scores reached all-time highs, and telehealth became more than just a quick video checkup.

Consider the case of a 17-year-old epilepsy patient named Courdell, who requires frequent visits to his neurologist. He recently “visited” his doctor’s office, accompanied by his mother, with a swipe on an app. As they ate breakfast, they received a reply text as Courdell’s chart was reviewed, and then his neurologist appeared on his phone. They greeted each other and discussed the results of his recent lab tests.

Courdell shared that he gets very tired during the day. His neurologist explained this was likely due to one of his medications, and they agreed to adjust the dose. Courdell and his mom waved goodbye, feeling a sense of security. This is not a futuristic scenario. Courdell is a patient of Nemours Children’s Health System in Jacksonville, Fla., and this visit occurred in their home last month.

Courdell lives in Georgia, 90 minutes from Jacksonville. He was only allowed to receive this care at home because the federal emergency has led many states to temporarily waive prohibitions on practicing medicine across state lines. Simultaneously, insurers relaxed their reimbursement policies to cover telehealth visits and even cover co-pays. The catch: these new policies have expiration dates.  

COVID-19 has disrupted or delayed care for millions of Americans while causing massive financial losses for our hospitals and clinics. Telehealth offers a promising way back to health for patients and healthcare systems. As a surgeon, I see more efficient and effective care for patients. As a health system CEO, I see a path back to financial stability that optimizes patient care. As an optimist, I see a transformational opportunity for our health system to make 10 years of progress in 10 weeks.

The federal government already has taken promising steps. The Centers for Medicare and Medicaid Services (CMS) is releasing guidance to states to expand access to telehealth. Now is the time for CMS to move a step further by extending the duration of these temporary measures. During this time, the government could collect best practices and develop all the necessary policy changes to create a permanent solution.

One of many silver linings to the fear and disruption from COVID-19 is how easily patients, providers, and insurers have embraced the benefits of telehealth. This valuable tool is poised to play a crucial role in the safe re-opening of our health system. CMS Administrator Seema Verma said it best: “The genie’s out of the bottle on this one.” I agree with her. There should be no going back. 

R. Lawrence Moss, M.D., is the president and CEO of the Nemours Children’s Health System.

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