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Telehealth During COVID-19: How Hospitals, Healthcare Providers Are Optimizing Virtual Care

Matthew Gavidia
Amid the COVID-19 pandemic, patients, as well as their physicians, have been put at risk while seeking or providing other healthcare. While several barriers to care have inhibited telehealth in the past, recent actions by CMS, HHS, and other governing bodies have sought to expand its availability nationwide. NYU Langone Health's telehealth service Virtual Urgent Care connects members with clinicians via phone or tablet to provide care without potential coronavirus exposure.
With intensifying concerns surrounding the COVID-19 pandemic, telehealth has become of paramount importance to ensure the safety of patients and physicians. As the regulations surrounding telehealth continue to be modified, nearly by the day, health insurance providers have enacted their own emergency plans to protect and care for beneficiaries.

Chief among them, NYU Langone Health has encouraged members experiencing flu-like symptoms to utilize their novel Virtual Urgent Care service, which connects members with clinicians via phone or tablet while at home, work, or on the go.

In an interview with The American Journal of Managed Care® (AJMC®), Paul Testa, MD, chief medical information officer of NYU Langone Health, noted that the service has experienced a “probable 10-fold increase in volume” in the past week. “That’s people who know that we offer the service, but we're also directing individuals who have symptoms or complaints or concerns to Virtual Urgent Care first, because telehealth is a perfect first frontline for this type of pandemic as it's emerging,” said Testa.

To account for the growing volume in patients utilizing Virtual Urgent Care during the coronavirus outbreak, Testa highlighted the importance of scaling as at the heart of any digital health response. “We're not dependent on the number of exam rooms we have, we're not dependent on the number of corners in New York City we're located at, but we're available to anybody in 5 states who wish to engage and come to us for care,” said Testa.

Initially, the service employed 35 physicians to address patient needs, but Testa notes that this number has substantially increased and will continue to rise as patient demand grows. When asked what advice is currently being given to patients experiencing flu-like symptoms, recommendations involved home and social isolation as symptoms resolved and following up with their primary care provider if needed.

“We certainly have a small percentage of folks who are getting referred into the emergency department (ED) for more severe symptoms or concerning presentation, but it's symptomatic relief and time, for the vast majority of individuals who experience a flu like illness,” said Testa.

Prior to the coronavirus outbreak, several barriers to virtual care, including proper reimbursement to providers and location constraints, proved to inhibit the availability of these services to patients.

Last week's bill approval by the Senate providing emergency funds to help mitigate the effects of the coronavirus sought to waive some of the financial and healthcare coverage difficulties in the United States, with additional alterations to telehealth statutes. While this potentially allows for a heavier reliance on virtual care among home-based care providers, institutions such as MGMA and the Alliance for Connected Care have issued letters to HHS and Congress respectively, seeking further action to implement new telehealth waiver authority for Medicare beneficiaries.

Aligned with these concerns, CMS recently announced their decision to waive cost-sharing for COVID-19 treatments and services delivered via telehealth as well as expanding access to certain telehealth services for Medicare Advantage and Part D beneficiaries. In an interview with AJMC®, Krista Drobac, MPP, partner of Sirona Strategies, stated that while she was not involved in providing consultation to CMS, “we are currently advocating for the Administration to waive anti-kickback regulations related to giving free telehealth visits in Medicare fee-for-service (FFS).”

“It makes sense to waive cost-sharing in an emergency. We don’t want to deter patients from consulting with a doctor at the same time we don’t want them to seek care in person,” said Drobac.

Beyond Virtual Urgent Care, Testa said that NYU Langone Health is expanding its usage of telehealth in health facilities as well by allowing nurses and clinicians to use their iPhones, called "clinical mobile companions," to engage a telehealth visit into a patient’s room without potentially exposing these healthcare workers to the virus.

Additionally, telemedicine carts have been deployed across all of NYU Langone Health’s EDs to assist the 150 emergency medicine physicians in handling surges inside the EDS. “ED has a set number of physicians, nurses, and clinicians in it. If they get hit with an extra 50 patients who are complaining of similar symptoms, we now have telemedicine capabilities to magnify the clinical team in the ED to take care of those patients,” said Testa.

As telehealth usage continues to grow in demand amid the COVID-19 pandemic, increased and sustained action from the US administration is warranted as “the authority Congress gave to HHS to waive telehealth restrictions in Medicare fee-for-service is narrow, time-limited and difficult to implement,” said Drobac. “Obviously we are pleased that telehealth restrictions are being addressed, but there is so much more to do. We must amend the language Congress passed last week to match how telehealth is delivered in today’s market.”

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