Telemedicine, also known as telecare or telehealth, has been used for many years to ease communication between providers and patients, and offers a convenient option for patients that require regular follow-up observation but are unable to ambulate easily due to medical comorbidities. When infectious diseases such as the coronavirus sweep the community, this type of service brings with it more relevance.
“I’ve gotten an immense amount of calls over the past few weeks,” says Jeffrey Fudin, PharmD, who launched a pain therapeutics virtual consulting service in late 2019 as an affiliate to the therapeutic applications firm Remitigate.*
And those numbers are only likely to grow. On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) officially broadened access to Medicare telehealth services so that “beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.” The changes fall under the federal emergency declaration.
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.” The ruling applies to doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, and more. As part of its announcement, CMS clarified the types of Medicare-based telemedicine providers can offer:
See additional details on the CMS change, including HIPPA updates. See also the updated clinical codes from CMS below. For those under non-Medicare plans, many payers are stepping up to relax rules and broaden coverage. AHIP has published a list of health insurance offerings around coronavirus.
According to Dr. Fudin, requests for virtual medical consulting have come into his firm from patients and providers alike. Patients are anxious about not being able to see their doctor for medication refills, treatments, or basic follow-ups, for instance. “Unfortunately, pain management in a primary care or outpatient setting may not always be on the top of a clinician’s list because there is no acute illness,” explains Dr. Fudin. As a virtual consult, Dr. Fudin says his team of clinical pharmacists does not communicate with patients directly unless specifically requested by the provider. Their expertise generally focuses on pharmacotherapy—and all it affects—after reviewing various predetermined diagnoses and medication history. “As the patient’s providers work with us, we can help to review full patient charts virtually via encrypted communication, provide recommendations, and reassure them that we are on top of the pain management aspect of their care,” he explains.
Remitigate Therapeutics typically works with primary care doctors who are not board-certified in pain management and who may need extra help with risk stratification for a patient (especially when polypharmacy or comorbidities are involved), or with ordering or interpreting a urine drug monitoring screen if the patient is on chronic opioid therapy. But in recent weeks, Dr. Fudin says he has been contacted by managed care groups and institutions who need telecare services on a temporary or trial basis because the coronavirus is overloading their usual systems. “They may triage the patients but they are not sure their needs are being filled, overall,” he explains. Sometimes, they have just a few specific questions that we can help answer, he adds, noting his team is typically able to provide immediate responses followed by written documentation in 2 to 3 hours
The provider can choose whether to implement the virtual clinician’s recommendations, but says Dr. Fudin, “We have had 100% of our recommendations followed to date. We also stay in contact with the office well after the initial consult in case prescribed doses need to be adjusted, and/or as the medication treatment plan progresses.”
In addition to Medicare-based telehealth, clinical pharmacy and specialty evaluations, telemedicine can also include physical therapy check-ins and telepsychiatry, the latter of which has been used by psychiatrists for years to offer patients evaluations, therapy, education, and medication management. Telepsychiatric services may apply to depression, PTSD, anxiety, and more.
Clinicians and patients alike may be concerned about prescribing and obtaining pain medication during the pandemic. However, with the current coronavirus declared as a public health emergency, providers are in fact able to prescribe controlled substances, such as opioids, via telemedicine. The DEA's Diversion Control Division has noted that, "For as long as the Secretary's designation of a public emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided the following conditions are met:
According to the DEA announcement, the term “practitioner” in this context includes a physician, dentist, veterinarian, or other person licensed, registered, or otherwise permitted, by the US or the jurisdiction in which s/he practices to prescribe controlled substances in the course of his/her professional practice.
With regard to reimbursement, adds Carrie Chitsey, Co-Founder/CEO of the browser-based telemedicine platform company One Touch Telehealth, the rate has now aligned with the average increase in revenue of $150K/per year. This may have to do with the fact that telehealth, in general, has grown 1400% in the past four years alone, she says. While One Touch does not focus on pain management exclusively, they are able to address primary care and hospital needs. “It is absolutely crazy right now with cancel/no-show rates over 50%. We are also doing telehealth to virtualize emergency rooms and hospitals for screenings,” she shares.
Pharmacist Consulting Services, PLLC, and Remitigate Therapeutics: Providing pain therapeutics virtual healthcare consult. https://paindr.com/virtual-consultations/
One Touch Telehealth: A virtual care telehealth platform for practice groups, hospitals, and facilities. www.onetouchtelehealth.com/
Neuroflow: Virtual behavioral health access and engagement across care settings, including for coronavirus. www.neuroflow.com/
Cliexa: This integrated pain management monitoring platform is now providing COVID-19 screening functionality. Telecare visits via mobile phones are available; custom intake flows and consent documentation sevices are also available. www.cliexa.com/
ModMed Telehealth: Modernizing Medicine is offering telehealth-enabled capabilities to help specialists continue seeing patients and provide critical care in a safe manner (eg, orthopedic post-op follow-ups for wound and range of motion checks; gastroenterological new patient consults and evaluations, screenings for emergencies, discussing pathology results). www.modmed.com/telehealth
Editor's Note: We will continue to add to this list. If your company is offering telemedicine or virtual healthcare for pain management or related services, or additional services to help combat coronavirus, please email the editor to get on this list at firstname.lastname@example.org
Telemedicine strategies for technology, troubleshooting, and etiquette with David Cosio, PhD, ABBP
The latest telecare rules from the American Psychiatric Association for those providing telepsychiatry services, including details on reimbursement and prescribing
Managing chronic pain and related symptoms during COVID-19
Managing rheumatic/immune diseases during COVID-19
PPM's full COVID and Pain Management Resource Center (updated regularly)
CMS. Fact Sheet: Medicare Telemedicine Healthcare Provider Fact Sheet. Available at: www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accesed March 25, 2020.
American Psychiatric Association. Telepsychiatry. Available at: www.psychiatry.org/psychiatrists/practice/telepsychiatry. Accessed March 25, 2020.
American Physical Therapy Association. Telehealth in Physical Therapy in Light of COVID-10. Available at: www.apta.org/PTinMotion/News/2020/3/16/TelehealthCOVID19/. Accessed March 25, 2020.
American Psychiatric Association. Telepsychiatry and COVID-10. Available at: www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-resources-on-telepsychiatry-and-covid-19. Accessed March 25, 2020.
Interviews with Dr. Fudin, Dr. Cosio, Carrie Chitsey.
*Disclosure: Dr. Fudin serves as an editor-of-large of PPM.