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Posted By: Susan M. Tiso, DNP, APRN, FNP-BC
April 14, 2020
Having worked as a nurse practitioner for almost 30 years, I have seen so much change and evolution in health care, from practice standards to system changes. However, I have never experienced such rapid change on so many fronts: Let's look at the recent changes in telehealth and Centers for Medicare and Medicaid Services (CMS) regulations.
In March 2020, President Trump issued a number of temporary emergency regulatory waivers impacting healthcare, which became effective immediately for the duration of the emergency declaration. Among these changes was an expansion of telehealth for NPs and PAs—among others—aimed at increasing safe access to health care for patients at home during the COVID-19 pandemic. The changes in telehealth include an increase in the type of services provided, the availability of telehealth to both new and established patients, the frequency of telehealth services, virtual check-ins, and remote patient monitoring. Importantly, billing capability was also expanded, and limitations lifted; new CPT codes linked to these services were provided by CMS.
It feels like a windfall for both clinicians and patients. Now, both can avoid travel to the office (transportation cost, traffic/travel time, possibly needing a driver, lost time from work, parking/cost), touching a lot of objects and surfaces, contact with multiple ancillary front and back office staff, check-in paperwork, the time and space needed to wait to be seen, the time in an exam room with the provider, and the repeat travel home. Harnessing relatively basic technology, which may be as simple and ubiquitous as a phone, tablet, or computer, patients can access providers and health care virtually and have their needs met in a COVID-19 free, safe, convenient, and efficient way.
In my practice this change occurred over a 2-week period—lightning speed. Initially, all non-urgent patient visits were offered by phone, then with video, and then a Zoom feature was added to our EMR system (Epic) software. Cameras and microphones were added where needed; training was blasted out to all providers; and telehealth visits became a reality. The parking lot is empty, the waiting room is empty, the exam rooms are empty, and providers' offices are empty as they are "seeing" patients from home. Very few patients actually want or need to be seen face-to-face, and if they do, we now have the capacity to accommodate this, easily. No more waiting for months.
We are seeing so many changes during this pandemic. Everyone asks what changes will remain when life as we knew it resumes, but I think telehealth is here to stay.
- Centers for Medicare and Medicaid Services. Medicare telemedicine health care provider fact sheet. www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed April 10, 2020.
- Centers for Medicare and Medicaid Services. MLN booklet: Telehealth services. www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/telehealthsrvcsfctsht.pdf. Accessed April 10, 2020.
- Centers for Medicare and Medicaid Services. Physicians and other clinicians: CMS flexibilities to fight COVID-19. www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf. Accessed April 10, 2020.