By: Matthew Byrne, PhD, RN, CNE, St. Catherine University
The COVID-19 pandemic continues to create challenges for many patients who are not able to safely seek care in face-to-face settings. Data collected from the first few months of the pandemic validate that telehealth was a critical bridge for these patients and for many others. The Centers for Medicare & Medicaid Services (CMS) released a report showing that 34.5 million telehealth services were delivered between March and June of 2020, representing a 2,632 percent increase as compared to the same time period in 2019 (Jercich, 2020). The incredible increase in telehealth visits, coupled with efforts to analyze patient outcomes and satisfaction, will factor in what the future holds for telehealth practice once the pandemic subsides.
In December 2020, the most recent iteration of the annual Physician Fee Schedule rules was released by CMS (2020). It largely preserves the expansion of covered services, maintaining changes made to reimbursement and increasing reimbursement for some services. These rules have an added benefit for nonphysician practitioners including nurse practitioners. They reduce documentation burden and offer greater supervisory and delegation opportunities, allowing for “top of license” practice.
A special report from Press Ganey Associates, released in May 2020, includes responses from a sample of 30,000 respondents and allows for a comparison between telehealth versus standard care delivered through April 2020. The care encounters were wide ranging in terms of the reasons for the visit as well as the ages of respondents. The results show a Goldilocks-type effect of mixed satisfaction in terms of care received and the technology involved. Younger patients (18-34) had the lowest rating of satisfaction in terms of care and technology. Middle-age patients (35-64) were closer to finding telehealth to be just right, while older patients had positive care experiences but lower satisfaction with the technology side. Opportunities for a better patient experience, beyond working through technology issues, include greater care coordination and teamwork in care delivery. The report recommends that providers be genuine, authentic, and empathetic during the interactions, set agendas for visits, and close the meeting with an opportunity to answer questions and identify a clear to-do list.
These early findings are now informing legislative agendas (Jercich, 2021) at the state and federal levels (notably HR7663 Protecting Access to Post-COVID-19 Telehealth Act of 2020), which will be needed to ensure that changes during COVID remain permanent and that additional barriers are removed. One of the biggest concerns remaining is efforts to close the digital divide for both patients and providers (Frith, 2021). Although telehealth can open new care pathways for underserved populations in rural settings, or those who have difficulty accessing care in a face-to-face setting, having sufficient internet bandwidth and devices for accessing that care must be simultaneously met by providers and patients.
COVID-19 vaccination rates, impacts of variants, global patterns of infection, and changes to safety protocols show the continued impact of the pandemic. In light of the potential for an even longer period of COVID threat for many patients, telehealth will continue to be that care lifeline. Federal, state, consumer, and provider efforts to ensure that telehealth is robust and adequately reimbursed will not only maintain its value to many, but ensure that the flexibility it offers and it promise to serve the undeserved remain, even after the pandemic has subsided.
Centers for Medicare & Medicaid Services. (2020, December 1). Trump administration finalizes permanent expansion of Medicare telehealth services and improved payment for time doctors spend with patients. https://www.cms.gov/newsroom/press-releases/trump-administration-finalizes-permanent-expansion-medicare-telehealth-services-and-improved-payment
Frith, K. H. (2021). Telehealth delivery model in the mainstream. Nursing Education Perspectives, 42(1), 65. https://doi.org/10.1097/01.NEP.0000000000000769
Jercich, K. (2020, October 21). CMS reports 34.5M telehealth services delivered March through June. Healthcare IT News. https://www.healthcareitnews.com/news/cms-reports-345m-telehealth-services-delivered-march-through-june
Jercich, K. (2021, January 25). U.S. lawmakers reintroduce House bill safeguarding access to telehealth. Healthcare IT News. https://www.healthcareitnews.com/news/us-lawmakers-reintroduce-house-bill-safeguarding-access-telehealth
Press Ganey Associates. (2020, May 19). The rapid transition to telemedicine: Insights and early trends. https://www.pressganey.com/resources/white-papers/the-rapid-transition-to-telemedicine-insights-and-early-trends