The global emergency health crisis, known as COVID-19, has placed pressure on the healthcare industry to rapidly revise the traditional practice of patient care delivery. "Coronavirus disease spreads primarily through contact with an infected person when they cough or sneeze. It also spreads when a person touches a surface or object that has the virus on it, then touches their eyes, nose, or mouth," according to the World Health Organization. This highly contagious disease dramatically shifts the delivery of patient care commanding revisions to federal regulations, and healthcare organizations' swift implementation of telehealth modalities.

To contain the spread of COVID-19, organizations are following federal recommendations to limit non-urgent ambulatory care and specialty in-person medical appointments for the safety of patients and staff. If there were no other safe alternatives available to deliver patient care, regardless of whether the organization is a large medical center or a small private practice, this recommendation would strongly affect the continuity of patient care and place a financial burden on the organization. This is where the implementation of telehealth comes into play.

The Center for Disease Control (CDC) supports and recommends telehealth implementation, stating that "Shifting practices to triaging and assessing ill patients (including those affected by COVID-19 and patients with other conditions) remotely using nurse advice lines, provider "visits" by telephone, text monitoring systems, video conferences, or other telehealth and telemedicine methods can reduce exposure of ill persons with staff and minimize surge on facilities."

What are Telehealth Delivery Methods?

Telehealth delivery methods are ways that patients, caregivers, and providers communicate medical care needs and can occur either synchronously or asynchronously.

1. Synchronous, also known as "real-time" communication, allows two-way communication between a patient, caregiver, and provider utilizing audiovisual telecommunication technology such as a smartphone, laptop, or desktop. These devices must have a camera and speaker capabilities for successful video communication. Synchronous encounters are considered the same as a traditional in-person encounter.

2. Asynchronous communication does not occur in "real time". There are various types of asynchronous telehealth communication.

  1. Mobile Health or mHealth is the provision of health care services and personal health data via a mobile device.
  2. Remote Patient Monitoring uses digital technology to collect patients' vital signs and answer a series of questions that are tailored to their medical diagnosis and care needs. This also allows patients to transmit their medical data to a secured medical platform for review and interpretation by a healthcare provider.
  3. Store and Forward allow the electronic transmission of medical information such as digital images, documents, and pre-recorded videos through secure email communication.

In order for healthcare organizations and private providers to successfully transition to video conferencing, regulations and policies needed to be revised to enable reimbursement for telehealth services. Prior to COVID19, no two states had the same policy and approach on reimbursement for telehealth delivery. These differences made it challenging for providers to provide care across state lines and non-rural areas. "The Center for Connected Health Policy's bi-annual analysis of state telehealth Medicaid policies found that although states occasionally use similar language in their policies, no two states are alike in how telehealth is actually defined and regulated".

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Broadening of Telehealth Delivery Methods

However, the Center for Medicare and Medicaid Services (CMS) has since broadened the regulations to permit telehealth reimbursements under the 1135 Waiver Authority and Coronavirus Preparedness and Response Supplemental Appropriation Act. "Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient's places of residence starting March 6, 2020."

In the course of several weeks, COVID-19 arose and dramatically shifted the delivery of health care from traditional face-to-face encounters to virtual visits. Organizations and private practices are taking advantage of the change in federal policy and transitioning in-person medical appointments to virtual appointments.

Patients are now encouraged to call their providers before coming in for unscheduled appointments. Telehealth modalities are being leveraged to keep people with a positive COVID-19 result or suspected exposure at home under observation. These patients are being monitored and educated on how to self-quarantine and protect both themselves and others in their homes from the spread of the disease. Dr. Christopher Crow, President of Catalyst Health Network in Plano, Texas, told the Dallas Morning News, "We're seeing a 180-degree change in how primary care medicine has been practiced in just a week or two. We're doing 10,000 to 12,000 virtual visits a day on our network, and that number could double by next week"

The COVID-19 health pandemic has shined a light on the convenience of telehealth appointments in lieu of in-person visits. It would be detrimental to return to "business as usual" and the traditional care model once this resolves, limiting access to health care and discontinuing telehealth in the process.


Janine Kelbach, RNC-OB
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