US Pharm. 2022;47(8):31-32.

The COVID-19 pandemic in recent years has changed the scope of healthcare delivery. Due to COVID-19, many healthcare services have been modified from face-to-face to virtual interactions between patients and providers. A number of new policies, such as changes in technology, Internet availability, prescriptions, and reimbursement for services, have affected healthcare and telehealth. These current changes have been implemented for the duration of the pandemic. Although these may or may not stay after the pandemic has ended, all healthcare must implement several factors for their future telehealth applications.¹

Telehealth, that is, the electronic exchange of information required for accurate diagnosis, efficient treatment, and ongoing care, can improve treatment access and efficacy. To promote physical distancing during the pandemic, many healthcare providers have shifted to virtual care delivery. Telehealth also expands virtual access to the healthcare workforce and particularly to under-resourced rural areas.¹

This article briefly reviews telehealth policies in light of the COVID-19 pandemic.

Telehealth Services and Policies

Telehealth services cover direct care through video communication, remote consultation, telephone face time, remote monitoring, provider-to-provider communication, and Web-based platforms. Although telehealth has become widespread, its uptake was not universal before the COVID-19 pandemic.^1,2 Telehealth uptake in the United States has been difficult due to barriers caused by reimbursement procedures, security concerns, technology availability, privacy, and prescription regulations.² Some of these barriers have now been removed through policy changes that apply for the duration of the pandemic.^1,2

In order to support COVID-19 physical distancing, some restrictions on reimbursement, security, licensing, and prescribing have been eased. For instance, the Centers for Medicare and Medicaid Services has expanded reimbursement for telehealth services for the duration of the COVID-19 pandemic. Support for reimbursement includes removing restrictions on the locations of the provider and the patient, expanding services, and ensuring payment parity.^1,2

Expansion of services includes different providers so that some healthcare workers, such as occupational and speech therapists, may now be reimbursed for services rendered via a telehealth program. In addition, patients and providers who previously had to meet face-to-face to be eligible for reimbursement are now permitted to meet each other virtually. Services that are eligible for using telehealth also include physical, occupational, and speech therapies; home dialysis; and substance use disorder treatments. Furthermore, telehealth visits via audio-only connection can be reimbursed at the same rate as for in-person, face-to-face visits.^1,3

Many states have now expanded telehealth coverage during the pandemic. Some states have participated in the Interstate Medical Licensure Compact to permit telehealth services across state lines. In addition, states have expanded telehealth modalities and payment equality, and some states have allowed for prescriptions via telehealth without a previous in-person exam.^1,3

The U.S. Drug Enforcement Administration (DEA) has eased the enforcement of rules for prescribing controlled substances via telehealth consultations. Until recently, the DEA required that controlled substances be issued via telehealth only after a previous in-person visit with the physician, a requirement that has been temporarily relaxed. Moreover, the DEA has indicated that healthcare providers do not have to register with the DEA in each state as long as they are registered in at least one state.^1-3

It is necessary that telehealth services have a stable technical framework. Unfortunately, some areas of the U.S. do not have access to broadband high-speed Internet with stable affinity. This can result in poor audio and video quality, disconnection, and incomplete information exchange. In addition, some patients and families in such areas may not have access to Internet at home to participate in telehealth. To expand reliable access to the Internet during the pandemic, the federal government now has an active grant program that supports healthcare providers. This program allows providers to expand their technical framework to support core care during the COVID-19 pandemic. Funding is available until the allocated funds are finished or the pandemic is over.^1,3

Healthcare providers must establish mechanisms to protect patient privacy when using telehealth services. Patient privacy is protected through HIPAA and through the Code of Federal Regulations. In response to the urgent need to establish services quickly, the Office of Civil Rights issued a statement indicating that consumer-facing technologies that do not necessarily meet traditional security requirements, such as FaceTime and Skype, smartphone apps, and verbal consent, are permissible during the pandemic.^1,4

The Future of Telehealth

Institutions must look at several factors when determining the future of their pandemic programs. As healthcare organizations review telehealth programs, they must consider questions across six key points associated with successful telehealth implementation and use. The key points are as follows:

During the COVID-19 pandemic, many behavioral and health providers switched to an entirely virtual status. After the pandemic, organizations will need to consider which services to offer in person and which to offer virtually. Telehealth services can be selected on the basis of geographic location, whether or not medication is needed, patient requirements, and organizational strategy.^1,3

Switching to a face-to-face and virtual care model requires operational changes. As an example, there may not be need for physical space if some staff and services move permanently to virtual care. Staff also will need direction on when and how to schedule virtual visits versus in-person visits. The workflow between virtual and in-person visits will need to be coordinated.^1,2,4

Many institutions have used technical assistance that may be good for short time. Technologies such as Skype and FaceTime were used during the pandemic, but it is unclear whether these technologies will stay postpandemic. Therefore, it is wise to move to a more permanent telehealth solution that can work with other health information technologies such as electronic health records. Some providers who were applying their own equipment during the pandemic may soon find out that this arrangement no longer works postpandemic.^1,4

It is important to train and engage staff when considering the future of telehealth. Staff must be trained in how to navigate both face-to-face and virtual care in the same practice and understand what kind of care works best in each delivery system. Finding interested parties for the future of telehealth and educating them to become a part of the organization are necessary for key operational components.^1-3

Some patients shifted to telehealth during the pandemic more easily than others. Patients may have to realize that changes to the virtual delivery system were temporary due to the pandemic; however, there are possibilities that due to the needs of the certain patient population, some services will continue to be offered virtually postpandemic. One case to consider is the specific telehealth needs of patients in rural geographic areas or those who may have transportation difficulties to personal visits.^1,5,6

Telehealth services can have financial implications for both healthcare organizations and patients. There are costs associated with integrating telehealth into ongoing operations, and payor support for telehealth may not be consistent. In addition, organizations that move to a value-based care model may wish to consider telehealth as part of this model.

Telehealth implementation happened quickly during the pandemic. As organizations plan for their future telehealth services, they should also plan how they will assess outcomes and how to use the results of these assessments to direct the future of their telehealth programs.^1,4-6

REFERENCES1. Haque SN. Telehealth beyond COVID-19. Psychiatric Services. 2021;72:100-103.2. Saljoughian M. The benefits and limitations of telehealth. US Pharm. 2021;46(8):5-8.
3. Dorsey E, Topol E. State of telehealth. N Engl J Med. 2016;375(2):154-161.
4. Jiang F, Deng L, Zhang L, et al. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med. 2020;35(5):1545-1549.
5. Jahanshir A, Karimialavijeh E, Sheikh H, et al. Smartphones and medical applications in the emergency department daily practice. Emerg (Tehran). 2017;5(1):e14.
6. Dellifraine JL, Dansky KH. Home-based telehealth: a review and meta-analysis. J Telemed Telecare. 2008;14(2):62-66.

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