Rheumatology and Telemedicine: Here to Stay or Passing Pandemic Fad?

Rheumatology and Telemedicine: Here to Stay or Passing Pandemic Fad? Posted By:
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In March 2020, the world changed for many of us. For those of us in healthcare, we found ourselves with new lives and new ways of trying to treat our patients. From questions of whether to continue immunosuppressive medications to wondering how to continue seeing immunocompromised patients during the evolving pandemic, flexibility and creativity were needed. Some providers switched patient care exclusively to telemedicine; others continued seeing some patients in office, but much of their practice was "seen" by video or audio telemedicine. In our office, we had quite a significant decrease in patient visits during the first few weeks of the pandemic. Patients were scared to come into the office. Within 1 week of the country "shutting down," our office started conducting telemedicine visits: We decreased the number of providers and staff in the building at 1 time and strongly encouraged telemedicine visits to all of our patients.

Much has happened since the first few weeks of the pandemic, particularly with the administration of vaccines and now boosters. During most of 2021, patients felt more comfortable retuning to the office for visits. However, many providers are still offering telemedicine visits for their patients and many patients are still utilizing them. There are multiple reasons for this. One reason is the reoccurring surges in COVID cases—with each new SARS-CoV-2 variant, now including Omicron, there is renewed hesitancy around interaction with the general public and unneeded exposures. For elderly or disabled patients, telehealth visits can be much easier than traveling to in-office visits. There are also patients who live great distances from their provider's office and for whom telemedicine visits are a great convenience. As more and more patients have completed telehealth visits, satisfaction with the platform has increased.

Though there are many benefits to telehealth for our rheumatology patients, there are concerns about the platform as well. One obvious concern is the objective examination of the patient. In rheumatology we are used to having a "hands on" approach to our patients—particularly examining the musculoskeletal system for synovitis, tenderness, and decreased range of motion.

Another major concern is reimbursement. Early in the pandemic, reimbursement was ensured as part of the federal public health emergency. Uncertainty about reimbursement grew as certain emergency orders were set to expire. However, on November 2, 2021, the final Physician Fee Schedule for the CMS was released and included an extension of telehealth reimbursement until the end of 2023. Still, there are questions regarding audio-only telemedicine visits and varying restrictions placed on telemedicine by individual state medical boards.

One last concern regarding telehealth is the subject of adequate in-office follow-up for patients. How long should providers allow a patient to conduct telemedicine visits before requiring an in-office visit? Certain state and federal policies have included a recommended time frame for in-office visits, with many requiring a patient be seen in office at least once every 12 months. The American College of Rheumatology has released statements regarding telehealth, with their primary statement being in support of "the role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic diseases, but it should NOT replace essential face-to-face assessments conducted at medically appropriate intervals."

The COVID-19 pandemic has brought much change upon the nation's healthcare systems. Overall, telehealth has led to significant increases in access to care. Patients are now aware of the convenience and ease of telemedicine visits. Some providers have stopped conducting telemedicine visits, but a larger majority have continued the practice and likely will make this type of patient care permanent. However, reimbursement issues and federal and state regulations may hamper that long-term goal in the future.

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Filed under: Rheumatology , Practice Management/Career

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