Although the rapid expansion of telehealth has been an essential part of keeping patients safe during the coronavirus disease 2019 (COVID-19) pandemic, the potential long-term effects of this expansion have not been fully understood according to an article published in JAMA Oncology.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services,” said author Trevor Royce, MD, MS, MPH, in a statement. “This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility. It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

According to Royce, this shift was made possible, in part, by several policy changes by the Centers for Medicare and Medicaid Services (CMS) as well as the 3 federal economic stimulus packages, all of which expanded Medicare recipients’ access to telehealth services. Some of these policy changes also allowed telehealth services to be provided in a patient’s home. Medicare had previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage.

Royce also noted the CMS approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for those services to be provided on a wider array of telecommunication systems, and altered the restrictions of who can provide and supervise care.

Although the benefits of these changes have been widely touted, Royce said they must be balanced with concerns about quality of care and patient safety.

“There is a lot we don’t know about telehealth and how its rapid adoption will impact our patients,” Royce said in the statement. “How will the safety and quality of care be impacted? How will we integrate essential components of the traditional doctor visit, including physical exam, lab work, scans and imaging? Will patients and doctors be more or less satisfied with their care? These are all potential downsides if we are not thoughtful with our adoption.”

With these concerns in mind, Royce said proper oversight is essential. Assessments will be vital, including patient-reported outcomes, physical examinations, and laboratory tests, as well as measurements of care quality and fraud monitoring. Standardized care quality measurements can be implemented during the transition to telehealth, including tracking emergency department visits, hospitalizations, and adverse events.

Other aspects to consider include technology and internet access, socioeconomic status, and comfort with technology. Royce added an overreliance on telehealth could also affect participation in clinical trials, which often require regular in-person visits.

“Telehealth can be used to improve access to care in traditionally hard-to-reach populations,” Royce said. “However, it is important to acknowledge that if we are not thoughtful in its adoption, the opposite could be true. For example, will lower socioeconomic groups have the same level of access to an adequate internet connection or cellular services that make a virtual video visit possible? Telehealth needs to be adopted with equity in mind.”

REFERENCE
Will telehealth services become the norm following COVID-19 pandemic? [news release]. UNC Lineberger Comprehensive Cancer Center; July 16, 2020. https://unclineberger.org/news/will-telehealth-services-become-the-norm-following-covid-19-pandemic/. Accessed July 28, 2020.