COVID-19 pandemic gives new sense of urgency to the need for regulatory reform

Pre-COVID, health providers across the country were working to redesign care delivery. Yet, progress was inhibited by regulations more reflective of yesterday’s technology and outdated provider reimbursement policies. The COVID-19 crisis can change that.

Winston Churchill famously said, "Never let a good crisis go to waste." While there is certainly nothing good about the coronavirus pandemic, it has catalyzed the transformation of American health care by accelerating progress in crucial areas.

The notion of a silver lining is not new. Others have suggested the far-reaching positive effects of the crisis from a regulatory perspective. I want to comment, however, on the opportunity the rollback of federal regulations presents in the area of telemedicine, specifically.

First, I commend the Centers for Medicare & Medicaid Services, Congress and the Department of Health and Human Services for their swift response to the COVID-19 crisis. Hundreds of CMS waivers now provide essential and much-needed flexibility for hospitals and health systems in areas hardest hit by the virus. These waivers have allowed the creation of additional hospital capacity and improved our ability to care for high patient volumes by streamlining the work of front-line providers, expanding the role of Advanced Clinical Practitioners, and reducing burdensome reporting requirements.

For many rural health systems where the surge of patients has not materialized, the regulatory relief is equally welcome. While we stand ready to respond, the unprecedented flexibility has, among other things, allowed us to adopt the tools essential for health care to join the digital revolution.

Pre-COVID, health systems across the country were working to redesign care delivery to improve access and convenience, and mirror the kind of experience consumers have come to expect in other parts of their lives such as banking, air travel and retail. Strategic plans aspired for the widespread use of innovative technology and telemedicine services, such as patient self-scheduling, video visits and e-visits. Yet progress was often inhibited by regulations more reflective of yesterday’s technology and provider reimbursement policies that excluded a wide range of service providers, as well as urban consumers and, most importantly, did not recognize consumer demand for visits from home.

The pandemic created a new sense of urgency to digital transformation both by consumers who needed to see their doctor but could no longer have face-to-face visits and by health systems experiencing precipitous drops in revenue as a result.

With the CMS waivers in place, we’re now able to bill for services conducted via telehealth by a broad range of providers for patients living in urban and rural areas, even when the patient is at home. Most of our appointments are by telephone, however, because many of our patients throughout our mostly rural service area have limited access to computers or smartphones and, in many cases, broadband technology. And with the pandemic threatening the survival of rural health care itself, entire communities may be left with telemedicine as their first option for routine care.

With regulatory barriers removed, the health care field has made significant progress. At Carilion, for example, what we thought would take us two years, we were able to accomplish in a matter of days. Now 75 percent of our ambulatory visits are virtual.

We’re conducting visits in multiple specialties, including family medicine, psychiatry, orthopaedics, dermatology and pediatrics, and across our mostly rural geographic footprint, with providers and patients reporting high levels of satisfaction.

Now that the telemedicine genie is out of the bottle, we must take the opportunity to make lasting policy changes to improve access and deliver better care for the growing number of patients who need it. We hope CMS will adopt the current waivers as part of a comprehensive overhaul to reflect the need for health care that serve people in the safest settings, including their homes.

While the pandemic has exposed many vulnerabilities in the U.S., it has also offered us great lessons. It has shown how we can collaborate in new ways to support one another -- something we could not have asked had it not been asked of us. So, I am hopeful for our future. I am confident that we will emerge -- both as a nation and an industry -- smarter, better, and stronger.

Nancy Howell Agee is President and CEO of Carilion Clinic, an integrated health care delivery system based in Roanoke, Va. She has been repeatedly named among the nation’s "100 Most Influential Leaders in Health Care" and "Top 25 Women Leaders."


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