The Future is Now: The Accelerated Adoption of Telemedicine in South Carolina

Posted On July 8, 2020

In the wake of the ongoing coronavirus pandemic, a wide range of changes in society, technology and healthcare have been accelerated exponentially by the extraordinary biological and economic forces at play. The adoption of telemedicine, or telehealth –the delivery of healthcare from a distance by means of audio and visual technologies– has been a clear example of such a shift. While telehealth had been slowly making its way into medicine’s mainstream in recent years, during the early weeks of the coronavirus’s spread in March and April, its utilization as a percentage of all healthcare visits increased from essentially 0% to 15%. Across the country, the move toward telemedicine was expedited by a roughly 60% decrease in outpatient visits during the initial surge of the outbreak.(1) In South Carolina and many other states, medical practices were further incentivized to adopt this new method of healthcare delivery when public and private insurers temporarily expanded reimbursement for certain services provided via telehealth, including well-visits, behavioral assessments and physical therapy.

Prior to the Covid-19 crisis, the ground rules for telemedicine were established in South Carolina by statute and guidance from the state’s Board of Medical Examiners. The South Carolina Telemedicine Act of 2016 (SC Code § 40-47-37 et al) addressed the fundamental standards for the practice of telemedicine, including requirements that the provider maintain a South Carolina medical license, a standard of care equal to in-person delivery of services, and patient medical records consistent with state and federal laws. In addition, both the Act and Board policies made clear that a physician-patient relationship cannot be established via telemedicine solely for the purpose of prescribing medications, and that prescriptions for controlled substances are not permitted unless specifically authorized by the Board. While the Act provided a basic framework for the authorized practice of telehealth in South Carolina, it left ample room for future legislation and refinement.

Such a dramatic shift to telemedicine across the nation has brought several issues to light that will require public discussion and policy changes in the coming months. One concern is that most of the expansions of telemedicine reimbursement were only provided for the short term “state of emergency” and will need to be made permanent through the proper channels. In the words of the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, the “genie’s out of the bottle” on telehealth reimbursement and “there’s absolutely no going back,” (2)  but it remains to be seen how payer terms and rates will be renegotiated once the pandemic subsides. This leads to the issue of payment parity, that is, the debate as to whether insurers will reimburse providers the same amount for telemedicine as for in-person services. Verma has said that she sees “potential savings for the system” in telehealth visits, which indicates that she is not in favor of strict payment parity for federal programs. (3) Private payers will be watching federal policy closely as they look to create their own cost savings through telemedicine visits at lower rates.

Another important issue is the originating site rule which, prior to its suspension by CMS during the pandemic, required that in order to conduct a federally reimbursable telehealth visit, the patient had to live in a rural area and utilize telemedicine facilities at a physician’s office or clinic. At a recent hearing on telehealth before the Senate Health, Education, Labor and Pensions Committee, Senator Lamar Alexander (R-Tennessee) advocated for the permanent removal of the originating site rule so that any patient could attend a telemedicine visit from anywhere, and most importantly, from the patient’s home. (4)

While the originating site rule has limited the patient’s location during a telehealth visit, state licensure barriers have limited a physician’s ability to practice telemedicine across state lines. To address these barriers at the federal level, legislators could define the provider’s location as the location in which the telehealth visit takes place for purposes of licensure and payment. State licensing boards will not be quick to relinquish control over the practice of medicine in their states, but potential solutions include waiving licensure requirements for licensed providers from other states, creating reciprocal agreements with neighboring states, and expanding the Interstate Medical Licensure Compact, which facilitates the licensure process for physicians preparing to practice telehealth across state lines. (5)

Many physicians in South Carolina have opened the door to telemedicine due to the remarkable circumstances of the Covid-19 outbreak, but much remains to be seen as to how the practice of telehealth will emerge on the other side as patients return to pre-pandemic comfort levels with in-person services. While many barriers to telemedicine have been removed out of the necessity of the current situation, the imminent decisions of politicians and policy makers on these issues will go a long way in shaping the practice of medicine in our state and the country as a whole.

(1) Mehrotra, Ateev; Chernew, Michael; Linetsky, David; et al. The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges. May 19, 2020. www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits.
(2) Parker, Jim. NHCPO: Make Permanent Telehealth Flexibilities for Hospice. June 11, 2020. www.hospicenews.com/2020/06/11/nhpco-make-permanent-telehealth-flexibilities-for-hospice/.
(3) Childress, Donna. Telehealth May Be Here to Stay. June 19, 2020. www.leadingage.org/cast/telehealth-may-be-here-stay.
(4) Robeznieks, Andis. How to maintain momentum on telehealth after COVID-19 crisis ends. June 30, 2020. www.ama-assn.org/practice-management/digital/how-maintain-momentum-telehealth-after-covid-19-crisis-ends.
(5) Wicklund, Eric. Experts Weigh in on Post-COVID-19 Telehealth Rules and Policies. June 15, 2020. www.mhealthintelligence.com/news/experts-weigh-in-on-post-covid-19-telehealth-rules-and-policies.