In response to the need for physical distancing, telehealth services were rapidly expanded for Medicare beneficiaries, but questions remain about the quality of care that patients receive through telehealth and the perpetuation of any patient disparities, according to an article published in JAMA Oncology.
The deregulation of telehealth services occurred through 3 federal stimulus packages passed in March 2020. “This effectively allowed the primary face-to-face patient-oncologist encounters (consultations, follow-ups, and, for radiation oncologists, on-treatment visits) to be conducted entirely virtually,” the authors wrote.
Prior to the pandemic, the US Centers for Medicare & Medicaid Services (CMS) covered specific telehealth services for patients receiving their health care in nonurban areas or where there was a shortage of professional health care providers. Other restrictions to providing telehealth included communication technologies that were compliant with the Health Insurance Portability and Accountability Act (HIPPA) and the eligibility of health care professionals who could participate in telehealth services.
The 3 stimulus packages, including the Coronavirus Preparedness and Response Supplemental Appropriations Act (CRPSA), the Families First Coronavirus Response (FFCR) Act, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, progressively loosened requirements for telehealth services.
Over 80 services are eligible for telehealth. Because CMS has agreed to not enforce patient eligibility requirements during the pandemic, patients can engage in telehealth visits with clinicians who they may not have had a prior relationship with, such as new consultations. These visits can be conducted through platforms that are not necessarily HIPPA compliant, such as Zoom, and audio-only visits are also now allowed.
Although the changes made by the federal stimulus packages were for Medicare beneficiaries, private payers have largely adopted similar changes.
However, deregulation of telehealth services has also loosened safeguards to ensure quality of care. “The foremost concern during the rapid adoption of telemedicine is maintaining the safety and quality of care,” the authors wrote.
The authors wrote that continuing to monitor quality metrics is important to determine the effect of expanding telehealth services on quality of care.
The authors also raised the concern about the technical requirements of telehealth visits potentially perpetuating disparities in care. “Understanding adoption rates of such at-risk groups as US citizens who are poor, elderly, or live in rural areas will be important.”
“The pandemic is likely to leave a permanent mark on society, and it is plausible that it will catalyze new models of care, including telehealth,” the authors concluded. “How telehealth affects the safety and quality of care, and how the regulatory landscape will look when the COVID-19 public health emergency is behind us, remain open questions that deserve continued observation.”
Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19 [July 16, 2020]. JAMA Oncol. doi: 10.1001/jamaoncol.2020.2684