How to approach this method of providing patient care in the present and future

By now, many U.S. practices have dabbled in telehealth. According to the American Medical Association (AMA), physicians and other health professionals are seeing 50 to 175 times more telehealth patients than before the pandemic¹. This, in part, stems from national emergency policy changes, known as waivers.

The COVID-19 global pandemic and related national emergency waivers created an opportunity and the flexibility for ophthalmology practices to readily try telehealth. Among the barriers in providing telehealth care² removed by the waivers:

• Allowing telehealth for both new and established patients
• Enabling providers to initiate/offer telehealth visits³
• Removing origination site requirements and geographic limitations
• Allowing the use of common technology to deliver telehealth care (e.g., Zoom and Skype), provided there is reasonable login security
• Increasing reimbursement to match in-office visits
• Implementing 2021’s anticipated Evaluation and Management (E&M) code changes early for telehealth services only, thereby allowing physicians to choose either medical decision-making or total time documented to support the E&M code of level of service chosen.

These temporary adjustments have increased telehealth adoption by practices and ensured access to care for patients during the pandemic.

Telehealth rules prior to COVID

Before the emergency waivers went into effect, delivery of telehealth was more restrictive and carried out for:

• Established patients only
• Patients who initiated the telehealth visit (per Current Procedural Terminology guidelines)
• Visits conducted with only HIPAA-compliant secure platforms, such as electronic health record portals, secure email, or other digital applications.

Additional barriers to the use of telehealth prior to COVID-19 included low reimbursement levels, which made telehealth a nonstarter for most practices, and ophthalmology’s need for hands-on examinations with slit lamps and ophthalmoscopes.

Today, the emergency waivers negate many of the previous roadblocks. To mitigate the hands-on issue, innovative practices are identifying visit types, such as simple conditions and follow-up visits, that lend themselves to telehealth. These internal and external efforts are allowing practices to expand and see more patients while honoring social distancing requirements.

Future telehealth use

As of this writing, telehealth flexibilities scheduled to expire near the end of July were extended for another 90 days.⁴ The extension of the national emergency declaration also extends its related waivers. When the national emergency ends, practices will need to ensure they are fully complying with the full code requirements. Hope is alive that many of the temporary waivers will become permanent, removing barriers to the continued use of telehealth and allowing practices to keep what has worked well during the COVID-19 emergency period.

Moving forward, stay apprised of current telehealth requirements and flexibility waivers and consistently share information within your practice so everyone remains updated. Practice compliance officers may subscribe to CMS newsletters and review ASCRS and AAO weekly newsletters, for example, as resources. Work to understand the types of telehealth options available, such as video, online communications, and phone call visits.⁵

Practices should also work to remain HIPAA compliant by using secure logins, performing telehealth visits in private areas wherever patients or providers are located, and documenting patient consent — verbal or written — before visits.

Staff may make the process efficient for providers by taking histories and gaining patient consent for the telehealth visit in advance.

By aligning your practice’s use of telehealth services with the current rules of the game, you can’t go amiss. OP

REFERENCES:

1. American Medical Association. How to maintain momentum on telehealth after COVID-19 crisis ends. https://www.ama-assn.org/practice-management/digital/how-maintain-momentum-telehealth-after-covid-19-crisis-ends . Accessed July 24, 2020.
2. Centers for Medicare & Medicaid Services. Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic. https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid . Accessed July 24, 2020.
3. Centers for Medicare & Medicaid Services. COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf . Accessed July 24, 2020.
4. U.S. Department of Health & Human Services. Public Health Emergency. Renewal of Determination That A Public Health Emergency Exists. https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-23June2020.aspx . Accessed July 29, 2020.
5. BSM Consulting. COVID-19 Telemedicine Code Matrix. https://bsmconsulting.com/Media/Default/Images/COVID-19/BSM%20Resource%20_COVID-19%20Telemedicine%20Code%20Matrix%20Updatedv2.pdf . Accessed July 29, 2020.