As the coronavirus pandemic swelled throughout the country, many healthcare providers found themselves abruptly pivoting – sometimes in a matter of days – to virtual care.
While larger health systems had the infrastructure in place to do so, many smaller practices struggled to keep up.
The hurdles to implementing telemedicine programs among smaller practices are fourfold, said Nate Lacktman, chair of the national telemedicine and digital health industry team at Foley and Lardner.
Historically, they’ve faced a lack of resources, a lack of strategic decision-making, a lack of time and attention to devote to telehealth, and a lack of reimbursement opportunities, said Lacktman.
Until regulatory changes, such as those enacted by the Centers for Medicare and Medicaid Services, had made telehealth provision more financially feasible, a doctor “had every economic incentive to require the patient to come to the office in person,” he explained.
“A fee-for-service-based reimbursement system is a very difficult sentiment to realign,” he added.
Patients, too, had not demonstrated significant interest before this spring. With the notable exception of mental telehealth, “among the traditional smaller practices, they hadn’t seen such a patient demand,” said Lacktman.
He pointed to the uptick in the adoption of telehealth software platforms targeted toward solo or small-group practices as an indication that providers had found themselves suddenly in need of lightweight, streamlined tools with a quick onboarding process.
For smaller practices looking to prepare for ongoing telemedicine needs, Lacktman says there are opportunities to think creatively.
“Take a weekend!” he said. “Think about: ‘What are my patient’s needs? Where are they coming from? What technology could benefit them and my professional staff at the same time?”
Telehealth need not entirely replace in-person visits, he said, but practices could, for example, offer after-hours consultations or asynchronous services for patients who need virtual care.
He also pointed to federally funded telehealth resource centers, which offer aid to providers at no cost and can provide regionally specific information.
Such centers acted as the “backbone of early growth of telehealth in the country,” he said.
For providers exploring vendor options, he said, “There are very low-cost types of telemedicine software platforms out there.”
However, he cautioned, the relaxation of HIPAA enforcement around telehealth tools “is intended to be time-limited.”
“I wouldn’t suggest a small practice try and build out a business plan” on non-HIPAA-compliant software, he said.
Of course, telehealth longevity largely depends on moves by state and federal lawmakers. In addition to permanently altering the CMS originating site rule – a change leading members of the Senate HELP Committee indicated they would be open to backing – and reimbursing providers for telehealth in non-rural areas, Lacktman pointed to statewide telehealth payment-parity laws as another potential catalyst.
As of October 2019, 42 states and the District of Columbia had enacted telehealth commercial payer statutes of varying kinds, according to a report Lacktman coauthored with colleagues at Foley. But only 10 have laws that allow providers to seek similar reimbursement for virtual and in-person services.
“By and large these laws don’t require plans to cover new and different services, or require plans to treat everyone the same,” Lacktman said. “If your benefit is a skeleton plan, it will remain a skeleton plan – just in telehealth.”