Only a few weeks ago, a Centers for Medicaid & Medicare Services (CMS) 1135 waiver opened up telemedicine services to millions of Medicare patients, becoming perhaps one of few silver linings as America grapples with COVID-19. The waiver enables medical groups and other providers to increase access at this critical moment in American health care.
Since then, high-performing AMGA member organizations such as Billings Clinic, Cleveland Clinic, and Inova Health System have rapidly adopted and expanded remote telemedicine and video medicine care for patients, especially for those with chronic conditions.
Medicare beneficiaries are now able to access care from the comfort of their homes. They are not risking exposure to the virus that causes COVID-19, which we know can cause deadly complications in people over 65 years old and/or with underlying health conditions. Providers, likewise, are limiting exposure while maintaining their connection with patients who, now more than ever, need support in managing their chronic conditions.
There are additional benefits too. To explore these benefits, I reached out to a few AMGA members. While some medical groups have established telemedicine programs for patients with chronic conditions such as Type 2 diabetes, others are just now launching initiatives in response to the waiver. One thing is clear: The waiver is accelerating change in the healthcare community, and the change is welcome.
Billings Clinic has depended on telemedicine since 1993 as a way to connect with rural Montanans. Due to Billings Clinic’s distinct patient demographic, parity in Medicare reimbursement for virtual and in-person visits is nothing new. Even so, over the past couple of weeks, Billings Clinic has experienced dramatic changes due to the waiver.
“All of the sudden, we are able to provide care to patients inside their homes, using everyday communications like Skype or FaceTime,” says Kristine Kilen, RD, CDCES, dietitian and diabetes care and education specialist at Billings Clinic Miles City. “Before the 1135 waiver, patients needed to visit one of our network-partnered telemedicine sites for virtual visits.”
Cleveland Clinic’s Endocrinology & Metabolism Institute has been promoting telemedicine for the past couple of years, and the number of virtual visits has increased slowly, as more patients and providers see the benefits and have access to the technology. Over the past month, however, due to COVID-19 and the waiver, virtual visits have increased by about 1,000%—from more than 100 visits in February to more than 1,200 in March.
This experience is demonstrating how important virtual care is in the management of patients with chronic conditions such as diabetes. “The biggest benefit is to be able to quickly and easily communicate, removing the need for patients to take extended time away from their personal and professional schedules to attend to their diabetes appointments,” states Institute Chair Bartolome Burguera, M.D., Ph.D. "More patients are realizing that it’s another way to access and connect with their provider.”
Inova Health System rolled out their telemedicine initiative in less than one week to urgently protect their patients and team members from exposure to COVID-19. The team at Inova had been eager to implement this initiative for some time, but the pandemic required a quicker turnaround. Telemedicine has been particularly beneficial for patients with chronic conditions.
For patients with diabetes, “telemedicine visits offer the opportunity to focus on education regarding medication adherence, diet, and physical activity to improve HbA1c control,” according to Dr. Neeta Goel, medical director for quality and population health. “Telemedicine visits save patients travel time as well as expense. Current CMS waivers have provided much-needed flexibility to offer care to patients anywhere in the U.S.”
Dr. Goel is already looking for ways to maintain these positive changes and continue to grow Inova’s telemedicine program after COVID-19 is no longer a threat. AMGA also is looking past the crisis and is asking Congress to consider sustaining the recent telehealth expansion or planning for it to be phased out slowly as providers return to normal operations.
With more businesses moving to an online format, it was inevitable that health care would follow suit. However, the evolution and expansion of telemedicine in the industry has moved so slowly over the past 10 years that no one anticipated it would happen at such an accelerated pace due to COVID-19.
COVID-19 has incited a telemedicine revolution, and now it is up to healthcare leaders and administrators to collect the data and tailor initiatives to maximize the benefit to health systems, providers, patients, and communities. We need to come together and harness the positive outcomes—the reduction in health disparities for patients with limited access to health care; the increased satisfaction, engagement, and education of patients; and the improved efficiency of providers —to ensure permanent change.
John Kennedy, M.D., is the chief medical officer of AMGA, and president of the AMGA Foundation.
