COMMENTARY

How to Start Doing Telemedicine Now (In the COVID-19 Crisis)

Neal Sikka, MD

Disclosures

March 25, 2020

The world has changed for telemedicine.

A couple of months ago, only a very small percentage of physicians used video visits. Some were not interested, while others were apprehensive about navigating the complicated regulatory landscape. Restrictive laws limited telemedicine use to rural areas, specific locations where the patient could be during the visit, and to patients located in states in which the physician has an active medical license.

But the COVID-19 crisis has changed everything. Through an emergency declaration made March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) will pay providers to care for Medicare beneficiaries for office, hospital, and other visits furnished via telehealth anywhere in the country—not just rural areas—and including a patient's place of residence. These services can also be provided in nursing homes, hospital outpatient departments, and other settings, and across state lines.

This goes into effect retroactively to March 6, 2020, and will extend through the COVID-19 public health emergency. The providers listed include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutritionists.

Other details include waivers or reduction in copays without any reduction in rates as they relate to in-person visits. These televisits do require real-time audio video interaction but are more flexible in that the video solution has an exception for Health Insurance Portability and Accountability Act (HIPAA) security rules requiring a business associate agreement (BAA) for technology.

That being said, it would be best practice to use a HIPAA-compliant video solution and work toward a BAA as quickly as is reasonable. While these new waivers are intended for patients with whom the provider has an existing relationship, the Department of Health and Human Services (HHS) has stated that it will not audit claims to ensure that a prior relationship exists.

To be able to start to provide these services quickly, HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against healthcare providers who serve patients in good faith through everyday communications technologies such Zoom, Doxy.me, Skype, and FaceTime, among others.

Here's How to Start Practicing Telemedicine

Physicians who don't want to deal with complicated technology have little to fear about telemedicine. This is not like implementing a new electronic health record (EHR) system, which has left many doctors feeling technology-averse owing to complicated integration into daily practice.

To participate in telemedicine on the most basic level, doctors only need a computer, a camera, a headset with microphone, and a secure platform that can manage telemedicine information. In fact, as mentioned, during this public health emergency, now doctors can perform telemedicine simply by using a smartphone and an app such as FaceTime or Skype.

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