News

By Kat Jercich

The COVID-19 pandemic triggered a flurry of changes to regulations around telehealth and virtual care – the vast majority of which expire once the public health emergency ends.

The current presidential administration and 116th Congress have each signaled their support for virtual care to various degrees over the past year. But neither took decisive, sweeping action that would permanently enshrine some of the major changes to telehealth policy.

So, the question on the minds of many telehealth advocates as President-elect Joe Biden prepares to take office is: What’s next?

“We are at an inflection point, and inflections bring new challenges,” said former senate majority leader Dr. William Frist, R-Tennessee, during the first day of the American Telemedicine Association’s four-part EDGE policy conference on Tuesday.

“Inflections demand changed perspectives, changed understanding, changed behaviors on our parts,” said Frist, a surgeon who is now a director at Teladoc and partner at Frist Cressey Ventures.

Frist noted that virtual care has exploded in the wake of the COVID-19 crisis. But the next steps, he said, will be safeguarding access to that care.

He noted the importance of allowing telehealth access regardless of patient and provider location, codifying a broader range of practitioners that can provide Medicare-reimbursable telehealth services, authorizing federally qualified health centers and rural health centers to continue offering telehealth, addressing cross-state licensing barriers, and treating all forms of communication equally, with regard to reimbursement, if providers can meet the same standards of care.

“There is a risk that broad telehealth deployment – if not carefully and thoughtfully designed – could replicate the barriers of the traditional bricks-and-mortar health system that produced disparities,” Frist cautioned.

Multiple panelists throughout the day raised payment parity as a particularly thorny issue. Frist noted, for example, while it was necessary to motivate physician participation during the pandemic, “since many overhead costs are totally eliminated in virtual transactions … some of these savings should flow to the patient as well as the provider.”

Similarly, Meghan O’Toole, health policy advisor for Sen. Brian Schatz, D-Hawaii, said “there’s a difference between payment during a pandemic … versus beyond.”

“Congress may not be the best suited to establishing payment rates for certain services,” O’Toole said.

“The [Congressional Budget Office] has consistently evaluated telehealth legislation as very expensive,” added Crozer Connor, senior legislative assistant for Rep. Mike Thompson, D-Calif.

In order for more lawmakers to give their full-throated support to telehealth reform Connor stressed the need for more data to support the quality of virtual patient care, saying, “What we need is payer data.”

“If we offer telehealth as an insurer, does that drive up utilization? Or is there a substitution effect?” Connor continued.

AVIA executive in residence Dr. Molly Joel Coye countered that in her panel, noting that plenty of data regarding telehealth’s effect on care exists, especially from the Veterans Administration.

“We do have data. We just don’t have it at the scale that COVID has now caused telehealth to be used,” Coye said.

Coye and her co-panelist Avalere Health senior advisor Wendy Everett forecast an overall rosy future for telehealth under President-elect Joe Biden’s administration.

“It’s mostly very good news,” Coye said.

She predicted that Biden’s administration will support the idea that broadband infrastructure alone will not be enough for parity in digital health.

It’s not just obtaining access to broadband, she said, but the ability to “pay for data charges, to have the appropriate devices and to have digital literacy” that makes a difference.

She pointed to “what I would call ‘the Geek Squad capability’ to come out and help people when it’s blowing up, and they just don’t know what to do, and they can’t make it work.”

Everett agreed with Coye that Biden’s administration “will absolutely keep the conceptual foundation that the Trump administration put in place.”

However, she noted, “there are some elements that the new administration will need to review.”

Again returning to payment for telehealth, Everett said, “We’ll likely move toward determining some level of fair payment rather than moving toward payment parity across the board.”

She also raised the importance of addressing the multi-channel delivery potential of telemedicine.

“How is [audio-only care] covered? What are we going to do about covering for text, for chatbots, for AI, for other ways of getting healthcare services to people who currently can’t get them?” she said.

One major way the next presidential term will be different, she predicted: “There’s going to be a lot of work done on expanding access to telehealth for those people who are broadly underserved.”

“Think about what they come in facing,” added Coye. “They are under the gun to show the public that they are going to do something really good for them in the next two years.”

Telehealth, she said, “is one of your key ways to make sure the public sees better access resulting from more insurance coverage.”

“We know there’s a very strong focus on equity and on access. But obviously the two are very tied together,” said Everett. If she were given the chance to pitch telehealth to senior government officials, she said she would propose, “Let’s come up with a plan for how to solve that digital divide: how to reduce the inequities and how to move telehealth across the country ubiquitously.”

By:  Scott Moody, MHA
National Telemedicine Policy Updates:

1. The Centers for Medicare and Medicaid Services (CMS) released the 2021 Medicare Physician Fee Schedule final rule on December 1, 2020. The 2,165-page final rule adds more than 60 services to the Medicare telehealth list.  These services will be covered even after the Covid-19 pandemic has ended. Early on in the Covid-19 crisis, CMS added 144 telehealth services to its coverage list through the end of the public health emergency.  Follow the link below for the list of covered telehealth services:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

2. R.133 – Consolidated Appropriations Act, 2021

The President signed Bill H.R. 133 into law on December 27, 2020.  The law does provide for expansion of Medicare telemental health services; however, it does come with limitations.  The law also provides other support for telehealth growth.  Please follow the link below for further detail:  https://preview.mailerlite.com/n8x5k1

3. R.7105 – Veterans Health Care and Benefits Improvement Act of 2020

The President signed Bill H.R. 7105 into law on January 5, 2021.  The bill requires the VA to ensure that veterans participating in or receiving services under a program for homeless veterans have access to telehealth services. The VA must ensure telehealth capabilities are available to such veterans, VA case managers, and community-based service providers.

4. R.7187 – HEALTH Act of 2020

On June 11, 2020, US Reps. Glenn Thompson (R-PA) and George Butterfield (D-NC) introduced bill H.R. 7187.  The bill proposes to make permanent Medicare coverage for telehealth services provided by Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC).  The bill also has language eliminating site facility and location requirements for distant site telehealth services.  The bill is currently in the House Energy and Commerce Committee and the House Ways and Means Committee.

5. R.5201 – Telemental Health Expansion Act of 2020

Bill H.R. 5201 proposes to modify the requirements relating to coverage of mental health telehealth services under Medicare.  Specifically, the bill removes restrictions that require the originating site (i.e., the location of the beneficiary) to be in a rural area and allows the home of a beneficiary to serve as the originating site for such services.  The Bill was discharged from the Committee on Ways and Means on December 24^th to go back to the entire House.

6. R.9035 – Permanency for Audio-Only Telehealth Act

Bill H.R. 9035 was introduced on December 18, 2020 and currently resides with the House Energy and Commerce and the House Ways and Means Committees.  The bill proposes to remove geographic restrictions for certain telehealth services and to expand the use of the home as an originating site for certain telehealth services.

7. R.8755 – Expanded Telehealth Access Act

Bill H.R. 8755 was introduced on November 16, 2020 and currently resides with the House Energy and Commerce and House Ways and Means Committee.  The bill proposes to the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes.

South Carolina Telehealth Policy

8. H 3230 – Medicaid Mental Health Reimbursement for Telehealth Services

H 3230 was introduced on December 9, 2020.  The bill proposes to require the Medicaid program to reimburse practitioners for mental health telehealth services.  The bill was referred to the House Committee on Ways and Means.

9. S 265 – Case of Laws of South Carolina, 1976, By Adding Section 44-7-400

Bill S 265 was introduced by Senator John Matthews on December 9, 2020.  The bill proposes to amend the Code of Laws of South Carolina to insert language to prohibit hospitals from utilizing telemedicine to deliver intensive or critical care services and to require such services be provided or supervised by a physician who is board certified in critical care medicine.  The bill has been referred to the Senate Committee on Medical Affairs.

Click Here for PDF of this report

Key regulatory flexibilities impacted by the COVID-19 public health emergency include higher Medicare payments for COVID-19 hospitalizations and telehealth reimbursement.

January 11, 2021 – HHS has renewed the COVID-19 public health emergency, extending key regulatory flexibilities such as Medicare telehealth reimbursement and higher rates for COVID-19 hospitalizations through April.

The 90-day extension of the public health emergency, effective January 21, 2021, will help hospitals and health systems battle the ongoing COVID-19 pandemic in their communities, HHS Secretary Alex Azar said on Twitter on Jan. 7.

“Our work to combat the virus will continue, as will our work to ensure a peaceful and orderly transition,” tweeted Azar, whose tenure as leader of HHS will come to a close when President-elect Joe Biden takes office later this month.

Biden has nominated Xavier Becerra, California’s Attorney General and one of the chief architects behind the Affordable Care Act’s defense in the current Supreme Court case, to be the next HHS Secretary, pending Congressional approval.

This is the fourth time HHS has renewed the COVID-19 public health emergency, with the last being in October.

The public health emergency, first enacted on Jan. 31, 2020, implemented a number of blanket waivers and regulatory flexibilities for healthcare providers to deliver fast, flexible care to infected patients while maintaining access to care for those without the novel coronavirus.

Increased telehealth coverage for Medicare beneficiaries was a key flexibility HHS has offered providers through the public health emergency. The department has added over 200 telehealth codes that are reimbursable during the public health emergency, including emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.

HHS has also allowed more types of providers to bill Medicare for telehealth services given during the public health emergency and granted waivers enabling reimbursement for audio-only telehealth services.

Through the public health emergency, HHS has also paid providers 20 percent more for caring for hospitalized COVID-19 patients and waived major rules, including the long-term care hospital (LTCH) site-neutral payment policy, the LTCH “50% Rule,” and the inpatient rehabilitation facility “3-Hour Rule” for all providers.

The department has also granted providers more flexibility with where they provide care to patients and waived certain reporting requirements for the duration of the emergency.

The waivers and regulatory flexibilities have been critical to provider response efforts to COVID-19, especially since the number of new cases, hospitalizations, and deaths continue to increase across the country.

But healthcare providers are also calling on HHS to make certain flexibilities and waivers part of the permanent regulatory landscape in healthcare. For instance, providers have urged the department to keep telehealth payment parity even after COVID-19 cases go down and can be managed by providers.

“Payment parity is an important policy because it affects their financial stability; in fact, before COVID-19, finances were a significant barrier to their using telehealth at all,” the University of Kansas Medical Center recently said in a Dec. report. “Some practices would not have started using telehealth were it not for COVID-19. The nature of the disease itself (the need for less physical contact and more social distancing) certainly drove some of the increase in telehealth offering and use, but the reimbursement and other policy changes likely also played a part.”

States have started to pass legislation making telehealth payment parity or payment at all permanent, but providers are calling for HHS to set the example and make telehealth a key part of Medicare coverage.

For now, blanket waivers and other regulatory flexibilities will last until April when the HHS Secretary will have to reassess the state of COVID-19 in the country.

For a comprehensive list of waivers and flexibilities, click here.

CARES Act provider relief payments disproportionately went to medically underserved areas, helping providers in already struggling areas to keep their doors open during the peak of lockdowns.

January 05, 2021 – At the start of the COVID-19 pandemic, the healthcare industry was confused, scrambling, and scared. Patients did not know when and where it was safe to seek care and providers were overwhelmed with patients needing care for a disease they did not know how to treat. Hospitals quickly hit capacity as ICU beds filled with patients needing ventilators while small physician practices had to close because no patients were coming in for care.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided economic stimulus and relief throughout the country amidst the COVID-19 pandemic and gave specific funding directly to providers and care delivery organizations. In total, this Provider Relief Fund allocated over $50 billion to Medicare fee-for-service providers for healthcare-related expenses or lost revenue as a result of COVID-19.

As telehealth quickly emerged as a catch-all solution to providers many challenges, Provider Relief Funding could support providers implementing these solutions without seeing a drop in revenue. Supportive policies from CMS and other payers relaxed restrictions previously limiting telehealth’s use and funded telehealth-based care.

Primary care visits delivered via telehealth grew by nearly fifty percent. But providers still needed support to rollout telehealth solutions and other technologies that improved patient access to care and kept safety at the forefront of care delivery. Providers needed to innovate if they were to keep their doors open and adjust practice to meet the demands of the time.

Funding from the CARES Act gave providers a needed economic boost when patient volume was at an all-time low and provide support to rolling out solutions that would keep facilities operating. An additional $18 billion was set aside for Medicaid and CHIP providers, including assisted living facilities. A final $20 billion was allocated for financial losses and changes in operating expenses to providers including, behavioral health providers.

A portion of the Provider Relief Fund was distributed based on the provider’s 2018 Medicare fee-for-service revenue. Additional funding was granted based on provider application, so those providers who were leveraging value-based payments were also eligible for funding.

New York, California, and Texas received the highest total number of payments across all states, according to the Department of Health and Human Services (HHS). Allocation strategy indicated that the areas hit the hardest by the COVID-19 pandemic would receive priority payment.

Over 40,000 payments were given to California providers alone, as this state has the highest number total cases across the county at over 1.5 million, according to data from the Centers for Disease Control and Prevention.

Payments ranged from $1 to $1,196,544,217 but averaged $265,759 for all recipients. HHS appeared to live up to its call as those areas hit the hardest by the COVID-19 pandemic received some of the highest payments.

But medically underserved areas also appear to have received higher total payments and average payments from the Provider Relief Fund than their counterparts in resource-rich areas, revealed an analysis from Xtelligent Healthcare Media.

Medically underserved areas are defined by the Health Resource and Services Administration (HRSA) as geographic areas that lack access to primary care services. Four elements contribute to an area being designated as a medically underserved area:

• Rate of primary care providers
• Percent of population at the federal poverty level
• Percent of population over age 65
• Infant mortality rate

A low rate of primary care providers for an area means patients have difficulty accessing care where and when they need it.

As primary care is central to care delivery and often the spoke behind care coordination, limited access to these services and results in poor care delivery and uncoordinated care. Previous research has shown that populations with a high proportion of primary care providers see lower mortality rates and improved life expectancy.

Poverty rates have also long been tied to health outcomes. Social determinants of health such as income and economic opportunity can correspond to a slew of health-related factors from accessibility of care to access to safe housing, all of which impact health outcomes.

Population over the age of 65 is likely also considered an element in the medically underserved designation as older patient populations typically have higher rates of comorbidities and chronic conditions.

These conditions, including diabetes and heart disease, require more and more frequent health services. A higher population over the age of 65 would suggest a stressed healthcare system or at least a healthcare system needing more resources to care for a sicker population.

Similarly, high infant mortality rate suggests poorer health status of mothers and thinned healthcare resources.

So medically underserved areas have the perfect storm of overextended care – fewer providers to care for a greater and more in-need patient population. These areas are in greater need of assistance to meet these needs of their complex patient population.

It is, therefore, reassuring that analysis from Xtelligent Healthcare Media found 240,461 more Provider Relief Fund payments made to providers in medically underserved communities.

Data on provider payments from HHS was paired with the HRSA’s indication of medically underserved populations to understand the relationship between relief payments and county-level resources.

The average payment for providers in medically underserved areas was over $20,000 higher than those in resource-rich environments. Not only does this data indicate that those areas in the greatest need received more payments, but they also received higher valued payments.

The difference in total payments to medically underserved areas compared to non-medically underserved areas was over $66 billion.

While reassuring that providers the most in need of additional resources were receiving aid, this data does not reflect the total impact of Provider Relief Funding in these communities because the data is only based on the payments accepted by providers at the time of analysis. Pending payments were not a part of analysis and reports from July show that nearly $100 billion had yet to be dispensed. Hopefully, this pending aid will continue supporting providers who are already stretched thin because of resource limitations in their communities and the impact of COVID-19 on their practice.

While priority was given to areas hit the hardest by COVID-19, the current wave of infections is sweeping the country irrespective of state and county lines. How HHS dispenses the remaining funds will be critical to support providers in areas with the most need.

It is a positive indication that medically underserved counties received over $66 billion more in aid than non-medically underserved populations, but is this enough?

For providers in areas where broadband is limited, HHS funding may not be enough to support equal access to telehealth services for their entire patient population. Or cancer care clinics whose patients are at the highest risk for developing severe COVID-19 may not have enough funding to provide safe and effective home care. Continued support to these areas will be critical moving forward as the pandemic continues to sweep the country.

Media Contact:

Joseph Calascione, (202) 418-2085

[email protected]

For Immediate Release 

Carr Welcomes Launch of Round 2 of FCC’s COVID-19 Telehealth Program

FCC Seeking Comment on Additional $250 Million for Successful Telehealth Initiative

WASHINGTON, DC, January 6, 2021—Today, the FCC released a Public Notice seeking comment on how to allocate an additional $250 million that Congress recently appropriated for the FCC’s COVID-19 Telehealth Program.  This new funding will allow the FCC to launch a second round of this successful telehealth initiative, building on the $200 million that Congress provided and the FCC awarded through this telehealth program last year.

Commissioner Carr has been leading the FCC’s efforts to develop telehealth initiatives that enable Americans to access high-quality care from their homes or anywhere outside the confines of a health care facility.  The FCC’s COVID-19 Telehealth Program builds off of those efforts.

“Over two years ago, we identified a new trend in telehealth,” Commissioner Carr stated.  “The delivery of high-quality care is no longer limited to the confines of traditional brick-and-mortar facilities.  With smartphones and other connected devices, Americans can now access health care services right from their homes or anywhere they have an Internet connection.  FCC staff have worked tirelessly to support this new trend in care, and the agency’s work to stand up the FCC’s COVID-19 Telehealth Program has been part of those efforts.  Congress has recognized that delivering care at a distance is part of the bright future for telehealth.  And it has now authorized an additional $250 million for the FCC to allocate through a second round of this successful program.

“I have had the chance to meet with many of the health care heroes that received Round 1 funding, and the FCC’s Telehealth Program provided them with critical support as they saw demand for telehealth services skyrocket in the wake of COVID-19.  I look forward to working with my FCC colleagues as we launch a second round of this successful initiative.”

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Office of Commissioner Brendan Carr: (202) 418-2200

www.fcc.gov/about/leadership/brendan-carr

BAMBERG, SC—Palmetto Care Connections (PCC) Chief Executive Officer Kathy Schwarting announces that Breanna Parham, NRCMA, PCT has been named Telehealth Coordinator.

In her position, Parham assists with the implementation and ongoing management of telehealth care in conjunction with standards, protocols, guidelines, policies and procedures. She works with pharmacies, churches and schools and other telehealth providers to set up telehealth programs, assisting as a tele-presenter when needed, and providing education and training on the use of telehealth equipment and services.

Parham’s strong clinical experience includes positions as a medical assistant and patient care technician for a busy Urology practice, phlebotomist for a regional hospital, and certified nursing assistant for a full-service nursing home. She received certification as a Nationally Registered Certified Medical Assistant (NRCMA) and as a Patient Care Technician (PCT) from Orangeburg-Calhoun Technical College.

“Breanna brings a wealth of clinical experience to our team,” said Schwarting. “Originally from Cordova S.C., she knows what it’s like to grow up and live in a rural area. Her background, combined with her career experience in medical settings have already proven to be tremendous assets in PCC’s initiatives to implement innovative telehealth programs in rural S.C.”

A resident of Rowesville, in her spare time Parham enjoys creating art and crafts using Cricut vinyl applications, gardening and spending time with family and friends.

Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in S.C. PCC leads South Carolina’s broadband consortium which facilitates broadband connections throughout the state. PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, partnering with health care organizations and providers to improve health care access and delivery for all South Carolinians.

By:  Cara Murez

TUESDAY, Jan. 5, 2021 (HealthDay News) — In late December, Dr. Ada Stewart asked her staff to check on a patient who had missed an appointment.

She soon learned that the patient had no transportation for the 45-minute drive, so Stewart offered to conduct the appointment by phone instead.

“It still accomplished so much. I was able to see how their diabetes was doing, how they were preparing for the holiday season, how they were really feeling mentally,” said Stewart, a family physician at Eau Claire Cooperative Health Centers in Columbia, S.C., and president of the American Academy of Family Physicians.

That’s just one example of how doctors are using telemedicine – having appointments by phone or video call – to check in with their patients.

Telemedicine isn’t new, but the COVID-19 pandemic has really put the technology front and center, with clinics closing for certain services after state and local governments issued stay-at-home orders to help prevent the spread of the virus.

And even when doctors’ offices were open, some patients avoided in-person appointments due to COVID-19 fears.

Besides giving telemedicine a boost, the pandemic has also fostered the rise of innovative medical services, everything from getting prescriptions by mail to drive-through virus testing and pharmacy-based vaccinations.

Many of those innovative approaches to health care are likely to linger long after the pandemic ebbs, experts say.

“We saw the benefits that telehealth provided,” Stewart said. “People were able to receive access to health care. We were able to reach out to our patients who were afraid to come into the office to be seen. It really afforded that opportunity to still take care of our patients and do so in a safe way.”

Telemedicine also gave physicians the ability to keep their practices, which might otherwise have been shuttered as patients stayed home.

“We had to pivot,” Stewart explained. “We had always talked about telehealth and incorporating it into our practices,” but 2020 brought the technology to the fore.

The American Academy of Family Physicians distinguishes between telehealth and telemedicine. Telemedicine, the academy says, is using technology to deliver care from a distance, whereas telehealth is the technology and services to provide that distance care.

Prior to the pandemic, telemedicine was already growing in the United States, especially in mental health services. But it still only reached a small minority of patients, about 4% of the population, according to Lori Uscher-Pines, a senior policy researcher at the nonprofit RAND Corporation, which works to impact policy through research and analysis.

Restrictions on telemedicine delivery were a major barrier to growth. For example, many insurance providers would only reimburse telemedicine visits under specific circumstances.

However, “at the start of the public health emergency, payers across the board really relaxed restrictions on telemedicine, so patients could be served at home and that would support social distancing and help patients continue to get the care that they need,” Uscher-Pines said. “As a result, we’ve seen telemedicine use really skyrocket.”

Enhancing, not replacing, in-person care

A study recently published in JAMA Network Open evaluated how health services changed in March and April 2020, during the early part of the pandemic in the United States, among 6.8 million people covered by commercial insurance.

The study found that use of in-person medical services dropped by 23% in March and 52% in April, and that telemedicine services grew by more than 1000% in March and more than 4000% in April.

That doesn’t mean telemedicine completely replaced in-person care: The increase in telemedicine only offset about 40% of the decline in office visits.

Prior to the pandemic, Deidre Keeves and her team at UCLA Health in Los Angeles had been trying to get physicians to increase their use of video visits with modest success, averaging about 100 visits per day for several months. But from March through May of 2020 they jumped to 3,000 to 4,000 visits per day, Keeves said.

More recently, UCLA Health doctors were doing about 2,700 telemedicine visits a day. Keeves said she expects that pace to continue averaging that number, even once the pandemic is under control.

She sees telehealth as beneficial for patients, who save on time and travel, as well as for physicians, who can reach a geographically wider population.

“We think that telehealth is here to stay. Our patients are expecting it. Our doctors are very happy with it, and it’s a great avenue for care,” said Keeves, who is director of connected health applications at UCLA Health. “We’re expecting that about 20% of our volume is going to continue to be through telehealth.”

In-person visits continue to be necessary anytime a person needs a procedure, such as a biopsy, lab test or vaccine injection, Keeves said. Telehealth works for follow-up visits, medication instructions and talking with a mental health provider.

UCLA Health is located in Southern California, a current crisis area for COVID-19. Keeves said staff are also monitoring some coronavirus patients at home with the use of pulse oximetry (which measures blood oxygen levels) and regular check-ins with clinicians.

“We at UCLA Health don’t feel that video visits are a replacement for in-person care,” Keeves stressed. “We are not using technology to replace the doctor-patient relationship. We’re using technology to supplement and support that relationship.”

Direct-to-consumer safety valve

What’s known as “direct-to-consumer” telemedicine was also growing even before the pandemic, Uscher-Pines added. That involves scheduling a visit with a doctor who works for an online-only service provider. It’s typically used when someone has a minor acute illness, not a severe condition.

Uscher-Pines was an author on a study that appeared recently in the Journal of Medical Internet Research. The study focused on the experiences of one such telemedicine supplier, called Doctor On Demand, a national telehealth service provider.

Researchers compared data from February to June in 2019 and February to June 2020. They found that total visit volume increased from March through April 7, 2020, by 59% above the baseline, before declining to 15% above the baseline through the week of June 2, 2020. The growth wasn’t typically fueled by COVID-19 concerns, but rather by visits for issues of behavioral health and chronic illness.

In this way, “telehealth services may play a role as a ‘safety valve’ for patients who have difficulty accessing care during a public health emergency,” the study concluded.

Pharmacies also fill gaps

Other innovations that have expanded during the pandemic range from drive-through COVID-19 testing to pharmacy-based vaccinations for younger children.

In August, the U.S. Department of Health and Human Services (HHS) authorized state-licensed pharmacists to vaccinate children age 3 and up. That followed a U.S. Centers for Disease Control and Prevention report, issued in May 2020, that found a “troubling drop” in routine immunizations for children.

“What I love about pharmacy is we’ve really stepped up to be a very essential access point for people when a lot of other things might have been closed,” said Sandra Leal, president-elect of the American Pharmacists Association and executive vice president of SinfoniaRx, which works with health plans to do comprehensive medication reviews with patients via telehealth.

Another change Leal noted is that pharmacists can now conduct COVID-19 testing within their communities. In April, HHS allowed licensed pharmacists to test patients for COVID-19.

As the pandemic forced office closures, SinfoniaRx’s team worked with patients to do not only the usual work of ensuring they had no medication questions, but also talking about COVID-19.

“We’re finding that so many people have so many questions around COVID and the pandemic, and vaccines and when they’re going to be available to them,” Leal said. “We’re really trying to address those concerns.”

Ordering prescriptions by mail is a service that’s been around for a long time, Leal said. In May, the Wall Street Journal reported that mail-order prescriptions had risen 21% over the previous year during the last week in March. Yet, Leal said patients are concerned about postal delays, which can be a big problem for people with certain conditions, such as people with type 1 diabetes who need insulin.

Future depends on policy

The COVID-19 pandemic has highlighted health inequities, and the shift to a broader acceptance of telemedicine is an opportunity to improve health care in the United States, Stewart said. She would like to see telemedicine continue, along with the technology infrastructure to ensure that health care is equitable.

Uscher-Pines said that it may be difficult to return to the pre-pandemic status quo, with its focus on office visits, because providers and patients are now familiar with and appreciate the convenience of telemedicine.

“I think that what ultimately happens with telemedicine really depends on how the policy environment evolves,” she said. “There is a lot of action going on at both the state and federal level right now on telemedicine policy, and a lot of strategizing on what should stay permanent and what should go back.”

More information

The U.S. Centers for Disease Control and Prevention has more on telemedicine during COVID-19.

SOURCES: Ada Stewart, MD, family physician, Eau Claire Cooperative Health Centers, Columbia, S.C., and president, American Academy of Family Physicians; Lori Uscher-Pines, PhD, senior policy researcher and research quality assurance manager, RAND Corporation; Deidre Keeves, PT, director of connected health applications, UCLA Health, Los Angeles; Sandra Leal, PharmD, executive vice president, SinfoniaRx and president-elect, American Pharmacists Association; JAMA Network Open, Nov. 5, 2020, online; Journal of Medical Internet Research, Dec. 15, 2020, online; U.S. Department of Health and Human Services, Aug. 19, 2020; American Pharmacists Association, Nov. 4, 2020; Wall Street Journal, May 12, 2020