Associate Editor of Managed Healthcare Executive, Briana Contreras, speaks with Drobac, executive director of Alliance for Connected Care, and a partner with Sirona Strategies, in Washington, DC, about the recent rise of telehealth in response to COVID-19.
Here is an exerpt of the coversation with Drobac:
MHE: We are now more than a month in past President Trump's declaration of national emergency and the expanded use of telehealth under CMS emergency rules. What has been the feedback you or any peers have noticed going on right now?
Drobac: An incredible rise in telemedicine visits. People are absolutely utilizing telemedicine platforms across all of our members, health systems, and vendors. Technology companies, we're seeing enormous numbers. The, for example, American Well (Amwell Medical Group) is doing 30,000 telemedicine visits per day. One of the hospitals in our group was doing two or three telemedicine visits per week in January and now they're up to 10,000 a day. So, you know, imagine the onboarding of physicians and teaching them how to do telemedicine visits, all while this is happening. It's like flying the plane while building it. So there's already a couple of patient satisfaction surveys out that show high satisfaction. So we're excited about that, but I would just say it's sort of exploded onto the scene, essentially.
MHE: Has the Alliance or any other entity gathered survey data on the effect of telemedicine at the practice level, especially among those who have not used it in the past?
Drobac: Not yet. I mean, what we do know so far is independent physician practices, in particular, are really hurting because there aren't a lot of elective visits happening and they are doing telemedicine visits, but it's not quite making up the volume that they previously had. So, you know, I think going forward, there's going to be an interesting discussion of how telemedicine and virtual care mix with in-person care. And how do you, you know, go back to a robust practice with, you know, your patients getting all their needs met, and how do you sort of split that up between what's virtual and what's in-person? But it is certainly on our roadmap of things to do, it was just the first month has just been trying to figure out the regulations and what it all means and getting it all situated.
MHE: How is the Medicare billing process going? Have there been any surprises?
Drobac: It's actually going pretty well. I mean, they have essentially waived everything, and there aren't really any guardrails around what can be reimbursed in Medicare. Most of the vendors that we have in our coalition like American Well, Care Innovations, they already have a relationship with Medicare enrolled providers, so they could serve patients through those avenues and didn't necessarily have to get enrolled in Medicare themselves.
Obviously, health systems are Medicare enrolled providers so they could just start seeing Medicare patients right away. There was some question about you know, the vendors that have physicians who are on staff. And how does that work because they don't have practices and they're not enrolled in Medicare? But honestly, there's been enough business, not necessarily business, but like consumers who need telemedicine visits coming through their existing relationships with hospital systems.
MHE: What about commercial payers? What are the successes and missed opportunities here?
Drobac: So commercial payers are waiving telemedicine visit co-pays, which is really big. Because not only do they see the value in it, but they're also saying it can be free. So, I think that's been a really big breakthrough. We had a breakthrough legislatively on the commercial side. There are 32 million people in this country with health savings accounts, and those are very, very strict rules for the IRS. In the third supplemental package, Congress allowed for free or discounted telemedicine visits for people with HSA, so that was a big deal because it means, essentially, health plans and employers can offer free or discounted services to people with HSA. And most of those people are in the large group market and the commercial market.
MHE: Are there any other conversations you're having in Medicare?
Drobac: Well, there's been a lot of conversation about technology. So what modality is appropriate? We've had, obviously video is fine and audio video is fine. That means essentially, you can use a smartphone that has to be video-enabled at any point during the call. And there were providers saying that they were missing patients because some patients don't have video capability, especially if you live in, you know, an underserved area and don't have Broadband. So there are a couple of codes that are audio only those are e&m treatment codes or audio only. But so far CMS has not made blanket, you know, audio only edition.
So that's one discussion in Medicare and other one is, you know, they waived temporarily the HIPAA compliance on the platform. So right now you can use Skype and FaceTime for example. You know, what does it look like going forward? I think most probably agree that HIPAA compliance is important.
So that's the temporary and then the other issue in Medicare really is: what are the program integrity guardrails for the future? The guardrails that were put in in the original bill were not workable, and so Congress just deleted them. So instead of amending them, we essentially don't have any guardrails right now and that's not necessarily good for the industry or stakeholders because, you know, we want the good actors to do well, and we don't want the, you know, doc in the boxes to just start, you know, dialing up Medicare beneficiaries. So that is one area that we still need to really work on.