Expanded provider reach, patient time savings boost popularity of telemedicine

Telemedicine saved many rheumatology practices from financial disaster during the early months of the COVID-19 pandemic. Today, business- and patient-savvy practices are using virtual visits to streamline patient flow and expand services to broader geographic areas than ever before, said Jesse D. Overbay, JD, Associate Director of Consulting and General Counsel, DoctorsManagement, Knoxville, Tennessee.

“COVID-19 changed the face of telemedicine forever,” he said. “Things we were all hoping for in November 2019 came to fruition very quickly. By April 2020, 78% of all [evaluation and management] billings were for telehealth visits. By mid-2020, two-thirds of adult rheumatology patients had attended at least one telehealth consult.”

Overbay discussed the business side of using technology to deliver clinical services to a remote location rather than face to face during Business of Rheum: Telemedicine and Strategies Beyond 2021. The session, which was originally presented on Monday, Nov. 8, can be viewed by registered meeting participants through March 11, 2022.

The concept of remote care is not new, Overbay noted. The idea was floated by Radio News Magazine in 1924, and in 1967, the University of Nebraska launched a two-way television system to send information and perform remote consults.  

More recently, the Affordable Care Act and meaningful use brought an explosion of cash-based telemedicine services, but reimbursement was rare, Overbay said. The Centers for Medicare and Medicaid Services (CMS) required remote consults to be conducted in a healthcare setting, typically a provider’s office or a hospital, to qualify for reimbursement. Neither patients nor providers could take advantage of telemedicine in the patient’s home.

“That changed forever in 2020 with the public health emergency,” Overbay said. “By the end of 2020, up to 90% of all physicians had used telehealth, about half of them for the first time. Rheumatology is the fourth leading specialty in telehealth use after psychiatry, substance abuse disorder treatment, and endocrinology.”

The COVID-19 pandemic created a need for expanded flexibility that allowed providers to use everyday technology such as FaceTime, Facebook Messenger video chat, Google Hangouts, Zoom, Skype, WhatsApp, iMessage, and more to provide virtual visits. 

Federal waivers and regulatory changes prompted by the pandemic essentially allow providers to deliver telehealth services to Medicare and Medicaid patients regardless of location, including across state lines, Overbay explained. State and federal changes brought coverage parity with in-person services, he continued. 

Providers and patients continue to use virtual visits for convenience and to reduce potential COVID-19 exposure. CMS has created uniform reporting requirements, but some private insurers have maintained their own standards.

Virtual visits offer important benefits to both patients and providers, Overbay said. Meeting online saves travel time and office wait time compared to in-person visits, he noted. Virtual visits are also easier to schedule and more likely to begin and end on time.

“Rheumatology is a very tactile specialty,” Overbay said. “There are times you need hands on the patient. But for patients who are stable, it is very easy to manage them remotely. And telemedicine allows you to serve a much wider geographic area knowing that at least some portion of visits will be remote.”

Once 25%-50% of patient visits go remote, scheduling becomes much simpler, he added. Many practices have gone to split days, with telehealth visits early and late in the day and midday hours reserved for in-person visits.

“Telehealth is here to stay,” Overbay said. “This genie is going to be very difficult to put back in the bottle.”