Rheumatology Group Issues Position Paper Supporting Telehealth Use

The American College of Rheumatology is coming down on the side of telehealth, with a position paper that lists six values of connected care and points out two areas of concern.

The organization was prodded to take action by the coronavirus pandemic, which has put telehealth in the spotlight and given healthcare providers more opportunities to try it out.

“The SARS-CoV-2 (COVID-19) pandemic has presented both challenges and opportunities to rheumatology professionals who have rapidly adopted telemedicine in routine practice,” Chris Phillips, MD, a member of the ACR’s Committee on Rheumatologic Care (CORC) and one of the position paper’s lead authors, said in an accompanying press release. “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.” 

“While telemedicine should not replace many of the hands-on skills and in-office assessments rheumatology professionals provide, patients in all areas of the US should have access to telemedicine, regardless of location, and the services should be included in all subscriber benefits and insurance plans,” added Aruni Jayatilleke, MD, a CORC member and co-lead author. “Additionally, rheumatology professionals should be reimbursed equitably for telemedicine services and have access to a streamlined state medical license process.” 

The seven-page document lays out the following positions:

1. The ACR supports the use of telemedicine to improve outcomes and increase access to care, but not as a replacement for essential in-person treatment.
2. The organization supports reimbursement parity for in-office, audio-only and audio-visual visits – including after the COVID-19 emergency is over – as long as the telehealth service meets the American Medical Association’s definition of a patient-provider relationship. In addition, the standard of care should be the same as that of an in-person visit, the encounter must be properly documents, and patients should be able to choose their provider.
3. The organization recommends that providers get approval from patients before using telehealth. This would include information on the telehealth process, the provider’s credentials and the limits of the technology.
4. The ACR supports privacy and security protections for patients “while balancing the need for access to telehealth services.”
5. The organization supports proposals that would allow providers to use telehealth across state lines.
6. The ACR supports outcomes-based research on the value of telehealth for delivering rheumatology care.

In addition, the organization identifies two areas of concern:

1. The ACR opposes geographical restrictions on telehealth use, including long-standing rules limiting telehealth use to rural areas and excluding the patient’s home as a telehealth site. Those restrictions have for the most part been eliminated during the ongoing emergency, and the organization supports making those restrictions disappear permanently.
2. The organization also opposes payer policies that mandate the use of specific telemedicine platforms, create restrictive networks of care or push patients toward preferred providers.

As with any specialty, telehealth offers particular benefits and drawbacks. The organization notes that virtual care can’t replicate a direct musculoskeletal exam or give providers an easy means of remotely monitoring changes in the musculoskeletal exam. It’s also difficult to measure certain disease activities without a “surrogate examiner.”

“Prior studies on use of telemedicine in rheumatology suggest a role for its use in monitoring established patients with rheumatoid arthritis, but evidence is limited in patients with other rheumatic diseases,” the organization says. “Thus, the ACR endorses the use of telemedicine but recognizes shortcomings of virtual visits and recommends that telemedicine be used in conjunction with periodic in-person visits.”

That said, the organization recommends that its members “study telemedicine rigorously with respect to outcomes of remote care, best use of less frequent in-person visits, and validation of remote disease activity monitoring.”