COVID-19 Shapes the Future of Telehealth

After telehealth regulations were temporarily waived to allow easier access amid the pandemic, legislatures and providers are working to expand some services permanently

By Maggie Dresser
Nicki Perisho, virtual health manager at Kalispell Regional Healthcare, demonstrates a telehealth visit on July 7, 2020. Hunter D’Antuono | Flathead Beacon

Before the coronavirus pandemic began limiting nonemergency hospital visits all over the country in March, Virtual Health Manager Nicki Perisho says Kalispell Regional Healthcare (KRH) was conducting an average of 20 telehealth visits a month.

But once the stay-at-home order went into effect, telehealth appointments multiplied to almost 500 per day. While the high volume of virtual visits scaled back to about 150 per day by early July, Perisho says the pandemic has paved the way for telehealth’s future and patients and providers are now recognizing its convenience and effectiveness.

While many patients are still anxious about coronavirus exposure in hospitals and medical facilities, Perisho says others who live in remote areas often drive hundreds of miles for doctor’s visits. Telehealth saves them time and money, and many patients simply don’t want to leave their home.

“I hear a lot of patient feedback saying, ‘it’s so easy sitting in my living room,'” Perisho said.

But while the pandemic has led to a skyrocket in telehealth visits, many of these appointments wouldn’t have been possible without a telehealth waiver to expand access after a federal public health emergency was declared under the National Emergencies Act.

Under the declaration, several federal regulations were lifted, allowing for easier telehealth access, including the requirement for all telehealth visits to take place at federally qualified originating sites. This means a patient would still have to go to a clinic or hospital located in a rural area with a healthcare provider shortage in order to connect with a provider.

But with the originating site requirement lifted, patients can connect with providers in the comfort of their own home, rather than heading to a clinic.

The Centers for Medicare and Medicaid Services (CMS) waived “the provisions related to telemedicine at hospitals and for Critical Access Hospitals,” according to the CMS COVID-19 Emergency Declaration Blanket Waivers.

While waiving the origination site establishes easier access for the patient, Perisho says some smaller medical facilities are feeling financial burdens since they are no longer being used for its origination site services.

CMS reimburses smaller hospitals around $28 when patients use their origination site, Perisho says, and without patients utilizing the clinic for telehealth services, small medical facilities are no longer receiving that extra cash.

“With people in their homes and not coming to the clinic, they are feeling that loss of revenue,” Perisho said.

Even though those hospitals are losing some revenue with the origination site waiver, Perisho says legislatures are pushing to waive the restriction, which expires in October, permanently to ease access for patients across Montana.

With bipartisan support, U.S. Sens. Jon Tester and Steve Daines are working to keep telehealth expansion permanent for Medicare patients. “We have all heard from our constituents about how effective and convenient it is,” said both Tester and Daines in a June press release. “Expanded Medicare coverage of telehealth services on a permanent basis – where clinically appropriate and with appropriate guardrails and beneficiary protections in place – would ensure that telehealth continues to be an option for all Medicare beneficiaries after the pandemic ends.”

“(They’re) now jumping on board and helping the telehealth fight that people in telehealth have been fighting for years,” Perisho said. “It’s better access for patients.”

But while telehealth advocates support permanently waiving the federal originating site, Perisho says there are other regulations that were lifted, which she hopes remain temporary. These include credentialing and state licenses, meaning a provider doesn’t have to be credentialed to give hospital orders or be licensed in the state they are practicing in.

“If a provider has done something where their medical license has been revoked where states keep track of providers, if nobody’s tracking those, that could be dangerous for patient care,” Perisho said.

As patients continue to utilize telehealth amid the pandemic, Perisho says the technology does pose some challenges, particularly with broadband internet access, especially since telehealth requires a strong connection for audio and video.

Providers are also experiencing difficulties with older generations who aren’t as familiar with technology. Medical staff typically has to walk elderly patients through the process before their appointment can start.

At Cabinet Peaks Medical Center in Libby, many elderly patients are choosing to go into the clinic because they aren’t comfortable with telehealth.

“While we have encouraged these patients and all patients in the high-risk population to stay home and complete their visits via telehealth, many of them are not comfortable with the technology and prefer to come into our facilities for their appointments,” said Kate Stephens, the public information officer at Cabinet Peaks Medical Center.

But while telehealth does pose some challenges, Perisho says it has evolved significantly since she started working in the branch of medicine in 2014. Between improving technology and provider acceptance, she says it’s come a long way.

“I feel like people are finally embracing and accepting (telehealth),” Perisho said. “It’s kind of crazy that it’s taken a pandemic.”

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