ACR supports 'expanded role' for telemedicine in rheumatic care beyond COVID-19
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The American College of Rheumatology has released a position statement in support of continued telemedicine access following the end of COVID-19 emergency measures, arguing it could help improve rheumatic care in the face of workforce shortages.
“The SARS-CoV-2 (COVID-19) pandemic has presented both challenges and opportunities to rheumatology professionals who have rapidly adopted telemedicine in routine practice,” Chris Phillips, MD, a member of the ACR’s Committee on Rheumatologic Care (CORC), said in a press release.
“As providers plan for rheumatology care post-COVID, taking into consideration rheumatology workforce shortages and geographically distant patients, it is apparent that telemedicine could help rheumatology providers improve care models for their patients if the long-term economic and regulatory landscape remains favorable,” he added.
Although rheumatology providers have advocated in the past for expansions in the use of telemedicine, their efforts have historically been hampered by federal and state regulations, reimbursement barriers and practical issues related to the provision of care, according to the ACR.
However, faced with a growing COVID-19 pandemic, federal and state officials have waived many of these restrictions, allowing rheumatology practices to provide telemedicine services, including audio-visual and audio-only visits, while curbing the disease’s spread and protecting staff and vulnerable patients.
Arguing that the value of telemedicine has been “undeniable” in preserving access and continuity of care, the ACR has crafted a series of eight position statements in favor of its continued, expanded role in rheumatology. These statements include support for the ongoing ability of patients to access telemedicine from their home following the end of the ongoing COVID-19 public health emergency, and opposition to geographic restrictions on telemedicine that limit its access to rural areas.
The ACR also declared support for continued parity of reimbursement for in-office visits, audio-visual visits and audio-only visits, both by CMS and by commercial payers, after the public health emergency has ended, so long as telemedicine services abide by four principles:
- Provider-patient relationship includes both in-person and telemedicine services in accordance with the American Medical Association Code of Medical Ethics, and specifically the ethical practice in telemedicine;
- Patients have a choice of telemedicine service provider;
- Standards and scope of telemedicine care are consistent with in-person services, with the appropriate steps taken to mitigate the limitations of available technology;
- The use of telemedicine services is properly documented.
Additionally, the statement calls for an end to payer policies that “dictate use of specified telemedicine platforms, use telemedicine services to construct restrictive networks, or which use telemedicine as a means to divert patients to their ‘preferred’ providers.”
Other provisions of the ACR position statement include support for:
- An efficient mechanism to secure informed consent for telemedicine services;
- Protocols to protect the security and integrity of patient information;
- Policies that facilitate interstate telemedicine;
- Outcomes-based research into the use of telemedicine in rheumatology.
According to the ACR, there remain several “areas of uncertainty” regarding telemedicine in rheumatology, despite promising preliminary evidence regarding its efficacy and cost-effectiveness. Outcomes-based research could potentially provide more information about the results of remote care and the best use of less frequent in-person visits, as well as provide validation of remote disease activity monitoring, the group added.
“While telemedicine should not replace many of the hands-on skills and in-office assessments rheumatology professionals provide, patients in all areas of the United States should have access to telemedicine, regardless of location, and the services should be included in all subscriber benefits and insurance plans,” Aruni Jayatilleke, MD, a member of CORC, said in the release. “Additionally, rheumatology professionals should be reimbursed equitably for telemedicine services and have access to a streamlined state medical license process.”
Perspective
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Telemedicine has been an invaluable tool for patient access and care during the COVID-19 pandemic, but it’s ongoing use post-pandemic will likely have a different face unless rheumatologists are instrumental in “best practices” and drive the regulation and reimbursement through demonstrating outcome-based research data to support the platform in our specialty.
The ACR position statement clearly outlines the need for telemedicine to increase access and improve care for those patients in remote locations, as well as those unable to utilize in-office care due to vulnerable conditions or difficulties getting to in-office visits.
Prior to the pandemic, the utilization of telemedicine was impeded by state and federal regulations, reimbursement issues and a host of barriers, including telemedicine platforms that could maintain HIPPA requirements. The ACR supports the ethical practice of telemedicine as it pertains to the patient-provider relationship with patients having their choice of providers, with care consistent with in-person services, retaining security of patient information, requiring informed consent and maintaining appropriate documentation.
In addition, the ACR is opposed to restriction of telemedicine service based on geography, payer policies dictating certain platforms and utilization of telemedicine to create restrictive networks to divert patients to preferred networks. ACR supports telemedicine to be included in subscriber benefits.
In order to support our position, outcomes-based research demonstrating results of remote care, best use of less frequent in-person visits and validity of remote disease activity monitoring are necessary. It is imperative that any future reforms include the position statements promoted by the ACR, and the best interest of the continuity of care for those patients unable to access in-person office visits. The future of the telemedicine platform should be driven by the physicians who provide care and those patients who benefit from it.
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