Telehealth has seen a significant surge since the first US COVID-19 shutdowns in March, with state and federal regulatory changes allowing for the necessary expansion of virtual visits. Remote provision of healthcare has only expanded since then, allowing for oncology navigators to incorporate telehealth into their robust repertoire, according to Jennie R. Crews, MD, MMM, and Janelle Wagner, RN, OCN, who discussed telehealth legislation, opportunities, and challenges in this relatively uncharted landscape.
“Historically, there has not been widespread adoption of telehealth, particularly in oncology,” Dr Crews said, adding, “And then along came COVID this winter and we had to quickly change our response.”
In response to the declaration of COVID-19 as a pandemic by the World Health Organization and as a national emergency by the President, the Centers for Medicare & Medicaid Services (CMS) issued an 1135 waiver, which loosened restrictions on telehealth services and created Medicare payment parity between telehealth and in-person visits. By the end of April, CMS issued a second round of regulatory waivers, allowing for all types of healthcare providers to bill Medicare for telehealth services, along with other provisions. Some of these provisions, however, will not continue into the 2021 Physician Fee Schedule, the presenters explained.
Federal and state legislation have also moved to expand telehealth access and coverage. If passed, a proposed telehealth “superbill” would further ease the widespread use of telehealth, including the establishment of a national telehealth program, as well as federal studies on the expansion of telehealth access under Medicare and Medicaid.
Although it is clear telehealth has a strong foothold, the presenters predicted regulatory changes when the emergency declaration is lifted, with state licensure requirements likely returning to their pre–COVID-19 status. Strong advocacy efforts are in place, however, to maintain the patient’s home as an acceptable originating site, payment parity or equity, and the wide array of providers currently allowed. In addition, efforts are underway to enhance patient access to telehealth through the provision of broadband and/or devices where the need exists.
“It has opened a whole new world for us, and I don’t see that going back,” Dr Crews said.
The presenters cited a 2-year tele-oncology trial at Intermountain Cancer Center in St. George, UT, as the first of its kind. Enrolling 158 patients who lived a minimum of 90 miles to the closest comprehensive cancer center, the program captured nearly $4 million in revenue while significantly reducing travel time and associated expenses, along with carbon emissions. Participants reported overall improvements in quality of life and other measures. The trial revealed the complexity of care coordination and the need for improved communication between distant healthcare teams.
A key component to tele-oncology, telenavigation is care coordinated by an oncology nurse navigator in tandem with the care team, patient, and family, using technology. Although the literature on tele-oncology highlights the importance of telenavigation, few data are available on its benefits, the presenters explained, adding that institutions should incorporate telenavigation and track its benefits to optimize this care modality for patients.
“With all the new laws that support telehealth, it’s just the time to bring this to your institution,” Ms Wagner said.