ACR releases position statement supporting the role of telemedicine in rheumatology

Reviewed by Emily Henderson, B.Sc.Jun 29 2020

The American College of Rheumatology (ACR) has released an official position statement supporting the role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic diseases. It also highlights the significant barriers and opportunities presented to patients and rheumatology professionals.

The SARS-CoV-2 (COVID-19) pandemic has presented both challenges and opportunities to rheumatology professionals who have rapidly adopted telemedicine in routine practice. 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, one of the statement's lead authors and member of the ACR's Committee on Rheumatologic Care (CORC)

The statement contains eight positions, including ACR support for:

• The role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic diseases, but it should NOT replace essential face-to-face assessments conducted at medically appropriate intervals.
• The need for continued parity of reimbursement for in-office visits, audio-visual visits and audio-only visits, both by CMS and by commercial payers, after the declared COVID-19 public health emergency (PHE) has ended, if telemedicine services abide by the following four principles:
  • The provider-patient relationship should include both in-person and telemedicine services in accordance with the American Medical Association (AMA) Code of Medical Ethics as it pertains to the patient-provider relationship, and specifically the ethical practice in telemedicine.
  • Patients should have a choice of provider for telemedicine services, as is required for all medical services.
  • The standards and scope of care provided remotely via telemedicine services should be consistent with related in-person services. The limitations of the relevant technologies should be recognized, and appropriate steps taken to mitigate these limitations.
• The provision of telemedicine services must be properly documented.
• Telemedicine platforms that provide an efficient mechanism to obtain informed consent for delivery of telemedicine services.
• Appropriate protocols to protect the security and integrity of patient information, while balancing the need for access to telehealth services.
• Proposals which would facilitate interstate practice of telemedicine.
• Outcomes-based research regarding telemedicine use in the practice of rheumatology.

The statement also includes ACR opposition to the following:

• Geographical restrictions on telemedicine practice including rural designation requirements, and, supports the ongoing ability of patients to access telemedicine services from their home after the PHE has ended.
• Payer policies which dictate use of specified telemedicine platforms, use telemedicine services to construct restrictive networks, or which use telemedicine as a means to divert patients to their "preferred" providers.

Telemedicine is the provision of health care services and education over a distance through the use of telecommunications technology. During the COVID-19 pandemic, many federal, state and reimbursement barriers were waived allowing rheumatology practices to provide telemedicine services (including audio-only and audio-visual visits) as part of ongoing efforts to prevent exposure to and spread of COVID-19 among providers, office staff and vulnerable patients.

Prior efforts on the part of rheumatology providers to expand use of telemedicine had been hampered by a multitude of factors, including federal and state regulations, reimbursement issues, and practical issues pertaining to the provision of care.

"While telemedicine should not replace many of the hands-on skills and in-office assessments rheumatology professionals provide, patients in all areas of the U.S. should have access to telemedicine, regardless of location, and the services should be included in all subscriber benefits and insurance plans," said Aruni Jayatilleke, MD one of the statement's lead authors and member of CORC. "Additionally, rheumatology professionals should be reimbursed equitably for telemedicine services and have access to a streamlined state medical license process."

Despite promising preliminary evidence regarding efficacy and cost-effectiveness of telemedicine in rheumatology, areas of uncertainty persist regarding the use of telemedicine in the specialty. More outcomes-based research regarding results of remote care, best use of less frequent in-person visits, and validation of remote disease activity monitoring are needed.

The value for patients, in terms of preserving access and continuity of care, are undeniable. Telemedicine's potential benefits, both during and after the COVID-19 pandemic, necessitate careful evaluation and investment for its success. Future reforms should include consideration for all the ACR's positions.