Telehealth, Arthritis Care and Covid-19
Improvements in technology and value-based health care initiatives have presented the telemedicine industry with opportunities for growth. Widespread implementation has begun during the coronavirus 2019 (COVID-19) pandemic. Previously, barriers have hindered the widespread adoption of telemedicine, including lack of awareness, implementation costs, inefficiencies, physical examination difficulties, overall lack of perceived virtual care benefit, negative financial implications, concern for medicolegal liability, and regulatory restrictions. Some of these challenges have been addressed with temporary state and federal mandates in response to the COVID-19 pandemic; however, continued investment in systems and technology as well as refinement of regulations around telemedicine are needed to sustain widespread adoption by patients and providers.
Because of the recent COVID-19 pandemic, policies have shifted dramatically. Temporary governmental mandates have allowed clinicians to provide virtual care for patients in states in which they do not hold licenses. These mandates have expanded telemedicine coverage for Medicare patients, improved reimbursement parity between in-person and telemedicine appointments, and in some cases provided reimbursement for care by telephone. Further, telemedicine appointments no longer must occur across HIPAA-secure options. Instead, they can take place through more accessible applications such as FaceTime (Apple), Doximity, and Skype (Microsoft). Several insurance companies have issued temporary amendments that largely mirror the federal mandates, but changes in coverage and reimbursement have differed between insurance carriers in various states.
Although recent changes have improved the ability of providers to care for patients remotely and have led to a dramatic rise in the number of telemedicine visits being offered, more sustainable and comprehensive changes are still required to support the integration of telemedicine into daily practice. Given the benefits and challenges of integrating telemedicine into orthopaedic surgery practices, providers must determine if shifting services virtually will remain beneficial to them and their patients once the pandemic resolves and the temporary mandates expire. Because many surgeons are now providing telehealth visits, those who do not may be at a competitive disadvantage as they may lose future surgical patients. The federal government committed hundreds of millions of dollars to help build the infrastructure necessary for virtual care through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and has already awarded millions of dollars to health systems to help them expand telemedicine options.
Ultimately, the widespread use of telemedicine in orthopaedic surgery is feasible. In addition to improving the cost and quality of care, developing virtual care pathways would prepare health systems for personalized care for diseases such as arthritis which is perfect for digital care. However, successful adoption of telemedicine is contingent on coordinated initiatives between doctors, patients, insurance companies, private enterprises, and health-care systems. By tackling the challenges of implementation and training, raising awareness and improving education, streamlining technology, and collaborating with patients, providers, and payors to align incentives, the field of orthopaedic surgery may benefit from telemedicine in the years to come. MyArthritisRx.com is a digital healthcare site for the self management of arthritis. Talk to your doctor about the value of arthritis self management.
Makhni, Melvin C. MD, MBA1,a; Riew, Grant J. AB2; Sumathipala, Marissa G.3 Telemedicine in Orthopaedic Surgery, The Journal of Bone and Joint Surgery: July 1, 2020 - Volume 102 - Issue 13 - p 1109-1115 doi: 10.2106/JBJS.20.00452
1 Department of Orthopadeic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2 Department of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
3 Department of Molecular and Cellular Biology Harvard University, Cambridge, Massachusetts