Online video, and even audio physician visits have been stymied for years by a hodgepodge of governmental and private payer restrictions. COVID-19 has changed all that, for now, but the future of telemedicine after the pandemic eases may depend upon documented protocols for its use and appropriate records of the online visits.
With lockdowns and social distancing and mutual fear of physical visits to doctors’ offices during the pandemic, more and more providers and patients are turning to online visits. These video (and sometimes telephone) patient encounters, generally lumped together as “telemedicine,” had languished for many years due to obstacles including low nonexistent payment to providers for these visits. Licensing barriers for clinicians to treat a patient located in another state (even one in which the patient had temporarily located, as many have done recently to avoid crowds in their home cities), also slowed the growth of telemedicine.
COVID-19 has moved telemedicine to the forefront. The Centers for Medicare and Medicaid Services (CMS) removed payment obstacles on April 30. Before that, on March 17, the Office for Civil Rights of the US Department of Health and Human Services (OCR) indicated that it would not enforce provisions of HIPAA that prohibited patient encounters over unsecured platforms like Skype and FaceTime (see OCR Announces Notification of Enforcement Discretion for Telehealth Communications During the COVID-19 Nationwide Public Health Emergency). OCR cautioned, though, that social media platforms like Facebook could not be used within HIPAA guidelines for telemedicine.
The continued viability of telemedicine will, like the delivery of all healthcare, be linked to financial incentives and they, in turn, will depend upon documentation. If the visit is to be paid for by government or private payers, there must be a record of it in order for payment to be processed Too few clinicians know how to record an online visit with a patient or to securely maintain it in an electronic file so that it can be produced for payers’ documentation or to subsequent caregivers.
“This crisis has forced us to change how we deliver health care more in 20 days than we had in 20 years,” Dr. Robert McLean a past president of the American College of Physicians, told The New York Times (“With Red Tape Lifted, Appointments Go Online,” May 12, 2020, printed version – page D7). And those changes can be quite beneficial. Dr. Emil Baccash told The New York Times “We get most of the information we need from talking to and listening to patients. And patients are more relaxed and feel less rushed in their own homes” (a version this article appears in print on May 12, 2020, page D7 of the New York edition with the headline: “The Doctor Will FaceTime You Now.”). For those benefits to continue and expand, accurate and secure records of those visits will be critical for patient care as well as the ability of doctors to get paid for that care.
If you have questions regarding the preparation of telemedicine policies and procedures, please contact Kenneth N. Rashbaum.