After a sharp rise in the onset of the COVID-19 pandemic and a slow decline that began in the summer, telehealth consultations in dermatology remain very high compared to those provided before the COVID-19 pandemic. But it is unclear whether the current rate will fall further, stay or even rise again, according to data presented and opinions expressed at a forum on the subject at the American Academy of Dermatology Virtual Meeting Experience.
According to several participants in a scientific session on the subject, there are many unknowns, including the future reimbursement of Medicare and Medicaid Service Centers and other external payers. He CURE The law, which was passed in the early stages of the pandemic, only provided a temporary increase in telehealth reimbursement. Post-pandemic payments for telecare services are yet to be determined.
Many of the experts gathered are convinced that teledermatology will continue to be offered at much higher rates than before the pandemic, but there are still many problems, including the doctor’s acceptance of this approach. This was reflected in an AAD survey of members in June 2020.
Dr. Jules Lipoff
“Seventy percent of dermatologists responded that teledermatology will continue, but only 58% reported that they intend to offer it,” he reported after the pandemic. Jules Lipoff, MD, assistant professor of dermatology at the University of Pennsylvania, Philadelphia, who is one of the authors of the work that reported the results.
The low relative proportion of dermatologists who plan to participate in teledermatology could at least partly reflect uncertainty about reimbursement, according to Lipoff, who is the outgoing chair of the AAD teledermatology working group.
Many dermatologists may find it difficult to opt for telehealth. In some types of care, such as follow-up visits, a combination of patient demand and institutional policy, especially if reimbursement is adequate, may compel or at least strongly encourage teledermatology services.
“Now that telemedicine has arrived, we will never return to normal practice,” Lipoff predicted. According to Lipoff, there was a wealth of data even before the pandemic to conclude that mobile dermatology is “an acceptable equivalent” to giving many types of dermatological care.
The rapid evolution of telemedicine is remarkable. According to the results of the AAD survey, 14.1% of dermatologists had experience in teledermatology before the COVID-19 pandemic, which increased to 96.9% in June 2020, when the survey was conducted. About 600 dermatologists completed the survey, with a response rate of 13.6%.
At the beginning of the pandemic, the CARES law, along with other changes in pandemic legislation and policies, changed the landscape of telemedicine by providing a proportionate reimbursement for office visits, modifying HIPAA regulations and reciprocal licensing to allow physicians to care for patients who had moved out of state. While these were one of the factors that facilitated the phenomenal growth of telemedicine, almost all of these changes were temporary or are subject to review.
Dra. Elizabeth Jones
“Refund [for telehealth] it was very low before the pandemic, “he noted Elizabeth K. Jones, MD, Assistant Professor of Dermatology, Thomas Jefferson University, Philadelphia. While many doctors and policymakers were convinced that reimbursement levels should be temporarily increased to provide medical care when office visits were unsafe, Jones said reimbursement rates are unlikely to be maintained. by pandemic. But recent CMS statements foreshadowed lower rates for most video and phone inquiries, he added.
Dr. George Han
Reimbursement is not the only consideration. George Han, MD, Ph.D., head of teledermatology at Icahn School of Medicine in Mount Sinai, New York, spoke of the frustration of using imperfect tools. He, like many dermatologists, has become familiar with the difficulty of making a definitive diagnosis from transmitted images of skin lesions.
As long as patients communicate with personal computers and telephones in varying lighting conditions, this problem may never go away, but suboptimal quality images do not necessarily preclude other types of consultations, especially follow-up visits, according to Han, who is also a system doctor. director of dermatology at Mount Sinai Health System.
“Now that patients know about teledermatology, they are,” he said. He suggested that greater efficiency of telemedicine follow-up for both patients and physicians could increase the frequency with which these types of visits are scheduled. Citing evidence that follow-up visits increase patient retention rates, Han has seen these visits among the usual uses of telemedicine when the pandemic is over.
At the height of the pandemic, teledermatology was widely used, but after the pandemic, Han and others predict a narrower approach. Some queries, such as for acne or other conditions reasonably treated on the basis of the patient’s history, appear to lend themselves to telemedicine. Others, such as a skin check to detect malignancy, may not.
As the role of telemedicine resolves and finds its balance in a post-pandemic world, Lipoff noted the need to consider populations without good quality Internet access. Without specific strategies to ensure these patients are not forgotten, he warned that “richer patients consume more of their fair share” of health resources, further widening the existing disparity.
“Is telemedicine here to stay? Obviously yes, somehow,” said Lipoff, who sees no reason for dermatology to be an exception.
Lipoff reported a financial relationship with AcneAway. The other researchers did not report possible conflicts of interest related to telemedicine.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.
