The Power of Telehealth Has Been Unleashed

C. Jason Wang, MD, PhD, Editor

Josip Car, MD, PhD, DIC, MSc, FFPH, FRCP (Edin), Editor

Barry S. Zuckerman, MD, Editor

Since the authors submitted their articles for this special issue of Pediatric Clinics of North America devoted to Telehealth for Pediatricians, the world has changed. The human race has been attacked by the most serious viral pandemic of our generation, the novel coronavirus disease 2019 (COVID-19). COVID-19 posed an unprecedented challenge to health delivery systems everywhere. As face-to-face clinic visits are no longer desirable due to the risk of catching the virus, COVID-19 has inadvertently aided the adoption of telehealth. The US Coronavirus Aid, Relief, and Economic Security Act passed by the US Congress has provisions to provide health care resources needed to fight COVID-19.¹ On April 23, the US Centers for Medicare and Medicaid Services (CMS) also released a tool kit for states to accelerate the adoption of telehealth in its Medicaid and Child Health Insurance Programs. The tool kit can facilitate the identification of barriers to deployment in areas such as populations eligible for telehealth, coverage and reimbursement policies, providers and practitioners eligible to provide telehealth, technology requirements, and pediatric considerations.²

In addition, CMS and the federal government have relaxed many previous restrictions on the use of telemedicine for Medicare to allow physicians to utilize telehealth during the COVID-19 pandemic.¹ Among them are key changes to Medicare telehealth payment policies to allow the same rate as in-office visits for all diagnoses; reduction or waiver of cost-sharing for telehealth visits and remote monitoring services, as well as code selection based on physician time spent on the date of visit or on medical decision making. Medicare also expanded access to telehealth to allow all settings (eg, home); both new and established patients; and consent for services at any time and has removed frequency limitations of Medicare telehealth services. Physicians can provide services from their homes; physicians licensed from 1 state can provide services in another state, but state licensure laws still apply. States also now have broader flexibility to use telehealth, such as telecommunications technology commonly available on smart phones (FaceTime, Skype, Zoom, and so forth), telephones, or remote patient monitoring; however, Facebook Live, Twitch, and TikTok or other public facing services are not acceptable to the Office of Civil Rights for HIPAA considerations. Ancillary health professionals, such as social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists, will have expanded access to telehealth during the crisis. For rural health clinics and federally qualified health centers, CMS will pay $92 for telehealth provided by physicians and other practitioners.

Given that the power of telehealth has been unleashed during the COVID-19 crisis, and over half of all visits during this period are likely to be telehealth services, health systems around the world may face the next dilemma: Would patients go back to the inefficient health care delivery systems they had before, where it often involves long journeys, including parking and waiting times, to the doctor’s physical offices? In this issue, authors write about policy perspectives and clinical experiences related to telehealth. It is hoped their ideas and experiences will serve as a framework for the future.