ACR Supports Use of Telemedicine for Rheumatology

Chris Phillips, MD

As the use of health technology and telemedicine has increased due to coronavirus disease 2019 (COVID-19), the American College of Rheumatology (ACR) has released a position statement supporting its use as a tool with the potential to increase access and improve care for those with rheumatic diseases.

The statement contains positions and oppositions for telemedicine, as well as highlights barriers and opportunities for patients and rheumatology professionals.

“As providers plan for rheumatology care post-COVID, taking into consideration rheumatology workforce shortages and geographically distant patients, it is apparent that telemedicine could help rheumatology providers improve care models for their patients if the long-term economic and regulatory landscape remains favorable,” Chris Phillips, MD, a lead author of the statement, said in a statement.

Although the ACR supports the use of telemedicine, the organization said it should not replace essential face-to-face assessments conducted at medically appropriate intervals. The organization also supports parity of reimbursement for in-office visits, audio-visual visits, and audio-only visits by the Centers for Medicare & Medicaid Services and by commercial payers since the end of the public health emergency if services abide by 4 principles: the provider-patient relationship includes in-person and telemedicine services, patients have a choice of provider for telemedicine services, the standards and scope of care provided remotely should be consistent with related in-person services, and the provision of telemedicine services is properly documented.

Major obstacles of telemedicine use on a federal level have included HIPAA regulations, originating patient site requirements, and poor reimbursement. The ACR supports protocols to protect the security and integrity of patient information while balancing the need for access to telehealth services. The organization also recommends telemedicine platforms provide a way to obtain informed consent for the delivery of such services, including information for patients or surrogates about the distinctive features of telemedicine, credentials of healthcare providers, and limitations of the technology.

Telemedicine services can be especially helpful for patients in rural populations who have limited access to specialty providers. The organization opposes geographical restrictions on telemedicine practice, including rural designation requirements, and supports the ongoing ability for patients to access such services from their home after the public health emergency is over.

When it comes to reimbursement, there are many inconsistencies in private payers’ coverage of telemedicine services. There is also poor coverage by certain state Medicaid programs, which has been a deterrent for healthcare facilities to implement telemedicine. Financial and administrative concerns have hindered the adoption of telemedicine services, even geographic areas in great need of such. The ACR opposes payer policies which dictate the use of specific specified telehealth platforms, use telemedicine services to construct restrictive networks, or use telemedicine as a mean to lead patients to their preferred providers.

Furthermore, telemedicine can be difficult for rheumatology providers to leverage because of the lack of a direct musculoskeletal exam and the inability to remotely monitor changes in the exam over time. It is difficult to measure some disease activity measures remotely, especially those dependent on physical exam findings.

The ACR supports and encourages outcomes-based research about the use of telemedicine in rheumatology. The organization also endorses the use of the services but recognizes shortcomings of virtual visits and recommends telemedicine is used with periodic in-person visits.

The full ACR Position Statement can be found here.