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Article April 7, 2020

COVID-19: Turning to telemedicine

Since the arrival of COVID-19, major measures like social distancing have been implemented and this has seen an acceleration in the use of telemedicine.

The use of telemedicine has been steadily on the rise for years, with companies around the world helping patients remotely. Since the arrival of COVID-19, major measures like social distancing have been implemented to fight the pandemic. This has seen an acceleration in the use of telemedicine, as providers look to make these technologies a fundamental component for interactions between patients and providers, while also maintaining safe and effective communications.

Regulation

The World Health Organization has consistently mentioned telemedicine among essential services in healthcare systems, however it has become a focal point since it was a highlighted in their recent report.

As countries globally announced new pro-telemedicine regulations for the duration of COVID-19, the US has gone a step further, signing into law the Coronavirus Preparedness and Response Supplemental Appropriations Act. The legislation includes $8 billion in emergency funding, with $500 million specifically allocated to telemedicine. The act will also waive certain Medicare requirements to expand reimbursement for telehealth services temporarily during the pandemic for 60 million elderly people. Several states have also temporarily waived certain licensure and other restrictions to permit greater utilization of telemedicine services during this public health crisis.

Safety

Despite pro-government initiatives, there remains a shortage of healthcare professionals in the hardest-hit areas. There has been panic from California to Calcutta over the lack of personal protection equipment (PPE) such as masks, gowns and eye wear, leading to many healthcare providers feeling like they’re “At War With No Ammo.

In a time when there are imbalances and shortages of healthcare professionals across the globe, being able to provide access to remote specialists from other states, provinces or countries has become a key asset. Using telemedicine solutions during these times has also seen healthcare professionals still offering care despite being in quarantine and eliminating the requirement for PPE and a sterilized working environment.

Providers

Many government agencies are urging the public and medical staff to use telehealth solutions for non-urgent communication to reduce the pressures facing emergency rooms and clinics. As a result, many health systems are adopting telemedicine to treat quarantined patients infected with COVID-19.

At Northwell Health Center in New York, they have increased the number for tele-ICU beds from 170 to 420 – this includes a telehealth command center where teams of critical care physicians and nurses are monitoring more than 130 beds (116 of which are COVID-19) patients. These physicians and nurses sit at banks of six to eight monitors, connected to two-way video conferencing systems to communicate with both patients and health professionals in the patient’s rooms.

Across the globe, there is still a learning curve to using telemedicine in the traditional provider/patient relationship. There is also a lack of technology hardware and without the widespread adoption of 5G technology, there could still be complications in the type of exam, such as camera quality and sound.

Risk management and insurance implications

From an insurance standpoint, there are myriad of emerging exposures which will undoubtedly arise from the COVID-19 pandemic and the rapid adoption of telemedicine solutions.  As a result of this uncertainty, many insurance companies are loathe to extend to any telemedicine consultations involving COVID-19 symptoms and a number have actively sought to apply absolute coronavirus exclusions.

Specialist telemedicine programs have their own network of broadly licensed physicians that are ready and able to work. That helps to remove the barrier of bringing new physicians into the mix – but with the surge in demand they may be unable to fulfill those promises, and health systems may look to non-specialist providers who do not have the same strict credentialing, training or on-boarding processes.

Assistance from all over the globe has been a key theme of the pandemic – healthcare professionals have been offering services outside of their normal jurisdiction or scope. This could become a key issue with many insurance products having tight geographical limitations.

In March the Drug Enforcement Agency (DEA) confirmed a Public Health Emergency Exception for Telemedicine. This enabled telemedicine providers to prescribe controlled substances, such as opioids with no in-person consultation – a potentially dangerous move with the opioid crisis still lingering.

Privacy also remains a topic of discussion – in the US, certain federal privacy regulations have been relaxed, regulators noted they will exercise “enforcement discretion” and would not impose penalties for non-compliance with regulatory requirements during the pandemic. For insurers, this might be the start of a slippery slope for slacked privacy controls. 

And what about the risks created as the healthcare and technology sectors continue to intertwine? Will policy triggers sufficiently extend to bodily injury arising out of healthcare services and technology activities? Will traditional healthcare providers ensure they’re carrying technology errors and omissions and intellectual property rights and infringement coverage?

Out of every crisis, a new opportunity arises. For telemedicine this might just be the opportunity, but this could all be for nothing, if the insurance community doesn’t step up to provide adequate insurance protection.