May 13, 2020
Washington's Transition to Telemedicine During COVID-19 Not Without Challenges
SEATTLE - Health care's response to COVID-19 necessitated that many health care services be delivered via telemedicine, significantly accelerating the transition to remote delivery of health care. Two months into the pandemic in Washington, doctors and medical practices are relaying to the WSMA their success stories - and some significant struggles - as they ramp up or adopt telemedicine delivery models.
Rodney Anderson, MD, president/CEO of Family Care Network, a network of local clinics located in Skagit and Whatcom counties, saw telemedicine visits go from about 1% in the beginning of March, to 60% only a month later.
"We completed our 10,000th telemedicine visit in early April," said Dr. Anderson.
In a recent WSMA statewide survey of physician practices, well over half were using telemedicine during the pandemic, and for those practices not using telemedicine, a clear majority were in the process of transitioning to using the technologies. The use of these remote care services was robust in those practices using them, with nearly a quarter using telemedicine for over half of their patient base. Approximately one out of ten practices using telemedicine indicated they used it exclusively when providing care.
For practices not using telemedicine, when asked why, a third (33%) pointed to a lack of clarity around reimbursement and another third (34%) indicated they encountered barriers to adopting the technologies. In a follow-up survey, when asked what challenges practices were experiencing with adopting or utilizing telemedicine, common responses included:
- Technical/connectivity issues.
- Patients having inadequate internet access.
- Issues with patient age and experience with technology.
- Appointments via telemedicine taking more time than in-person visits.
- Struggles obtaining reimbursement from insurers.
Seeing the benefit of telemedicine to physicians and patients, the WSMA has successfully advanced key telemedicine bills in the legislature over the last several years. To facilitate the transition to offering telemedicine services in response to the outbreak, Gov. Inslee issued a proclamation that immediately - and temporarily - implemented Senate Bill 5385, requiring that physicians be paid for telemedicine services at the same rate as if those services had been provided in person. On May 4, the governor extended the order through May 31, but further action is needed to keep telemedicine payment parity in place until the operative provisions of SB 5385 take effect (as per the original bill) on Jan. 1, 2021.
As Washington state and the rest of the U.S. settle in for a protracted battle to slow the spread of the novel coronavirus SARS-CoV-2, the WSMA is urging both public and private health care policymakers to prioritize policy that facilitates the use of telemedicine technologies.
At the federal level, the WSMA is supporting the proposal from Rep. Kim Schrier (D-WA) that addresses another pain point frequently mentioned by physicians - reimbursement from self-insured ERISA plans for telemedicine services. HR 6644 would require ERISA plans to pay at parity with face-to-face services for care delivered via telemedicine.
The WSMA is also advocating for equal payment for another common remote technology - telephone visits. While not generally considered telemedicine, telephone visits are frequently used by physicians for some routine services, especially those delivered to the elderly, who may not have access to or prefer not to use a computer. Like telemedicine, telephone consults have become a vital strategy used by physicians to deliver patient care during the outbreak.
Like virtually all of our state's businesses, physician practices have been financially impacted by the pandemic. Washington physicians report that patients have delayed or cancelled appointments or procedures for other medical conditions, with some care being delayed pursuant to state orders restricting non-urgent procedures. Telemedicine payment parity has been a life raft for many of our state's practices, helping to keep practices afloat and facilitating access to care for patients across the state.
"The benefits of moving to telemedicine during an infectious disease outbreak like COVID-19 are well-understood: Patients can continue to see their physicians without the need to travel to a practice and risk exposure for the patient or the health care team," said William Hirota, MD, president of the Washington State Medical Association. "It's very important that everyone continue chronic care management and routine care without disruption or delay, to ensure that patients are being properly managed during this time of social distancing."
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About the WSMA
The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.