April 23, 2020

APSHO Webinar Empowers Advanced Practitioners to Utilize Telehealth During COVID-19 Pandemic

By A. Kate MacDougall

As people around the world are staying home to reduce the spread of the novel coronavirus, telemedicine has proven to be a powerful and necessary tool. But for many health-care providers, including advanced practitioners, limited experience and constantly evolving rules and guidelines have made it difficult to know where to start. A recent Advanced Practitioner Society for Hematology and Oncology (APSHO) webinar detailed the ongoing relaxation of regulations and provided helpful tips on setting up and using the technology for efficient and safe patient care.

Jason Astrin, PA-C, MBA, DFAAPA, director of Advanced Practice Provider Services at The US Oncology Network, led the April 7 webinar, “Establishing Telemedicine During the COVID-19 Pandemic: Expert Advice for Oncology Advanced Practitioners" and answered attendees' questions. Astrin explained that pre-pandemic, the Centers for Medicare & Medicaid Services (CMS) had fairly strict rules around the use of telehealth, including limitations on which patients could use the service, from where they could conduct virtual visits, and on which type of HIPAA-compliant platforms. In addition, many commercial insurance companies did not pay for telemedicine services.

“Our lives have changed in the past several weeks,” Astrin said. “However, cancer care hasn’t changed, and cancer certainly hasn’t taken a break. We still need to be able to reach our patients, particularly in the oncology setting, which has our most vulnerable patients.”

And in response to these pandemic changes, CMS temporarily lifted some of the telemedicine restrictions, starting on March 3. This included removing patient population and location criteria, expanding telemedicine use to more types of clinicians, and authorizing the waiving of copays for virtual visits. The regulations were further relaxed in an update on March 30.

“Practically any E/M service previously provided in the office during a face-to-face encounter can now be provided via telemedicine at the same level of reimbursement,” Astrin said. “And very importantly, [CMS] loosened the regulation around licensed physicians and [APs] being able to practice outside of their state of Medicare enrollment.”

But knowing the current regulations for telehealth is only part of the preparation. Astrin stressed the importance of setting up a telehealth team who all have reliable remote access to electronic medical records and are well versed on the telehealth visit type and billing code process and patient consent guidelines. He also said it is important to choose a simple virtual platform and make sure all staff are comfortable using it.

“The good news is, prior to COVID-19, Medicare was very strict on what those [virtual] platforms could be. You couldn’t just pull out Skype and start talking to your patient,” Astrin explained. “[Now] any non–public-facing remote communication is appropriate and acceptable…like Skype and FaceTime, for example.”

During this trial by fire, many advanced practitioners and other clinicians, as well as patients, are becoming comfortable with and perhaps even beginning to prefer telehealth to in-person visits. Post-pandemic, we may even see telehealth become commonplace in more areas of medicine, such as survivorship visits, chemotherapy education, and genetic counseling. However, Astrin warned, don’t expect regulations to remain this relaxed forever.

“I think we will always practice medicine a little differently after COVID-19,” Astrin said. “And I think most of the prior restrictions on telemedicine probably will come back…[and] become a little more restricted. However, Medicare is also learning about the [importance of] improved access to care and quality.”

Advanced practitioners can view a recording of the webinar and watch a Q&A video with Astrin and Vogel.

Read more from the APSHO Advance: Special COVID-19 Series