COVID-19 eases telemedicine's shackles, expansion looks bright for orthopedics

Alan Condon -   Print  |

In the midst of the COVID-19 pandemic, a significant number of healthcare providers have shifted to telehealth and telemedicine to provide care for their patients and ensure the safety of their staff.

The telemedicine program at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., has been in operation for more than five years, where the hospital's orthopedic department primarily uses the technology for surgical discussions, imaging reviews, provider-to-provider consultations and  postoperative visits. 

Providers have been embracing telehealth's expanded indications, outlined by CMS in March, but how will the landscape look for the technology on the other side of the pandemic?

Alfred Atanda Jr., MD, director of the Center for Sports Medicine at Nemours/Alfred I. duPont Hospital for Children , and Suken A. Shah, MD, division chief of the Spine and Scoliosis Center at the hospital, spoke to Becker's Spine Review about utilizing telemedicine in their practices and what the future holds for the technology.

"Telemedicine technology has been around for decades but what's really going to change and be re-imagined is how we use that technology," Dr. Atanda said.

"Once patients get a small taste of the technology's convenience, I think they'll realize that they can now get high-quality care at their fingertips, just like a lot of other factors of their lives, such as ride-sharing, e-commerce, and video streaming," Dr. Atanda added. "When we come out on the other end of this I feel like patients are going to be not just requesting, but demanding to be able to continue to get their care without having to attend an in-person visit."

As the U.S. healthcare system continues its move from a fee-for-service model toward a more value-based payment structure, Dr. Atanda believes that finding ways to keep patients out of the hospital — in conjunction with their own demand for not wanting to visit the hospital — will revolutionize how we deliver care. 

Patients and providers are now being forced to use telemedicine due to the pandemic, which may be the catalyst that the technology needs to break further into the mainstream.

"CMS has loosened up a lot of its telemedicine guidelines, but moving forward, I'm sure they'll be tightened up again. Knowing your state's guidelines and regulations is going to be huge," Dr. Atanda said. "When you come up with a digital health offering, you have to look into hardware and software issues — what are you going to physically do the telemedicine visit on?"

"Telemedicine isn't new for us, and we've been able to scale it up and adapt it very quickly because we have that prior experience," said Dr. Shah, who began using the technology in his practice about 18 months ago, finding it particularly useful for out-of-town patients.

"We treat a lot of patients with rare diagnoses that are willing to travel, but we can save them a trip if they're not quite ready for surgery, describe the whole surgical process, and even do a virtual exam before they get there," Dr. Shah added. 

"There are cost and time savings. Plus, postoperatively, when their children are still relatively uncomfortable from surgery, mobility can be a challenge. So, I think from a patient satisfaction and patient comfort standpoint, they love doing the post-op visits via telemedicine."

As with any technology, there can be some bumps in the early adoption stages. Setting the technology up for success means understanding the billing and licensing issues that arise with telemedicine, supporting administrative staff involved with the service and choosing the right supplier.

"You have to find software that's within your budget, but also HIPAA secure, where the supplier of the software establishes an agreement to protect the health information and figure out what to do if there is a potential data breach," according to Dr. Atanda.

"Connectivity is key: both audio and high quality video are very important," Dr. Shah added, "because you want the experience to be pleasant. When people start getting frustrated with technology I think that takes away from the experience."

Medicare has been relatively restrictive with how it reimbursed for telemedicine services, but has started relaxing some of its regulations and policies, even before the pandemic, according to Dr. Atanda. 

Currently, it is applying broad coverage to what it will reimburse, including in-person visits and visits that occur via email. And as a result of the coronavirus pandemic, patients can now access care across state lines, which Dr. Atanda hopes will stay in place once the virus is contained.

"That will really kick-start things and help get over that hump of early adoption. Previously, people didn't want to engage with telemedicine because they were afraid of reimbursement and how it might affect their revenue ," Dr. Atanda said. "I think that now we are overcoming the licensing and billing hurdles, a lot more surgeons are going to embrace telehealth technology."

Ultimately, the bottom line will be in terms of reimbursement, which has been one of the biggest hurdles for the advancement of telemedicine in orthopedics, according to Dr. Atanda.

However, with the relinquishing of some of the technology's shackles and widespread adoption over the past month, the future of telemedicine is looking a lot more favorable toward reimbursement for Medicare, Medicaid and commercial payers.

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