Lindsay Lowe is an associate attorney at Wolfe Pincavage, a Florida boutique law firm whose entire career has been dedicated to public health and health care law. She's exceptionally well-versed in healthcare-related matters and a variety of transactional, regulatory, and managed care matters. Her expertise is derived from years of representing healthcare providers in healthcare licensure, healthcare fraud, waste and abuse, and healthcare compliance matters. Lindsay has generously spent time answering questions with a forward look at business post the COVID-19 crisis.
How can telemedicine make the U.S. healthcare market more efficient?
The increased use of telehealth services will likely make the U.S. healthcare system more efficient and will improve access to care for aging individuals and those in rural and underserved areas. The increased use of telehealth services will likely result in the preservation of healthcare supplies and resources -- resulting in a better allocation of PPE, prioritization of in-office services, and decreased in-office wait times – lessening the potential spread of infection and ensuring patient safety.
How will health insurance policies change to incorporate telehealth services?
With an uptick in the use of telehealth services, insurance carriers will likely expand their benefits to include these services. CMS recently expanded telehealth benefits for individuals with Medicare coverage, and waived copayments for behavioral health telemedicine services. However, if commercial insurers fail to incorporate or expand telemedicine coverage in health insurance policies, this may result in a lack of coverage for individuals seeking telehealth services as well as reimbursement issues for providers rendering these services.
What are the potential interstate licensure and reimbursement issues?
Some states are loosening licensure requirements for telehealth providers during the COVID-19 pandemic. Traditionally, physicians do not have licensure reciprocity across states, which means that physicians may only perform telehealth services in the state(s) where s/he is licensed to practice. While, nurses participating in the multistate licensure can provide telehealth services in their home state and other compact states. In terms of reimbursement for telehealth services, patients/providers must verify the patient’s eligibility for telehealth services to avoid non-coverage and a lack of reimbursement for providers rendering telehealth services.
Are there any expected changes to health costs post COVID-19?
Insurance premiums for commercial insurance coverage will likely increase in efforts to offset increased costs incurred during the COVID-19 pandemic, which include the lack of funding for elective procedures, the need for supplies and resources, and the payment of overtime hours for various health professionals.
Will pop-up hospitals be incorporated into hospital systems emergency policies? If so, will they adhere to different billing and coding rules?
There is a likelihood that some healthcare facilities may choose to incorporate pop-up hospitals into their hospital systems, providing improved access to care, hospital space and utilization. Hospitals relaxed their coding and emergency room rules and procedures due to the need for a rapid response to the COVID-19 pandemic. Various hospital and building design professionals have already suggested best practices for pop-hospitals, which focus on proper heating, ventilation and air-conditioning, in efforts to prevent disease transmission in all buildings.
What does comprehensive global health security look like post-COVID-19? How will the crisis change the U.S. care model?
There will be a “new normal” post-pandemic, with continued testing of trends to detect potential outbreak and research for a potential cure to remedy COVID-19. This unprecedented global pandemic will lead to an increased awareness of mitigation strategies, such as monitoring the number of individuals permitted at public gatherings/spaces, restarting of elective procedures, and public cooperation in improved sterilization.
How will the crisis change the U.S. healthcare system?
The COVID-19 pandemic will have lasting impacts on the U.S. healthcare system in terms of emergency preparedness, allocation of resources and funding, the transmission of information, and how consumers seek healthcare services post-pandemic. One significant change is the increased use of telehealth services, coupled with the revision of healthcare policies to include/expand telehealth benefits, the promotion of virtual visits, the preservation of resources, and the greater access to care.
Will there be an uptick in healthcare fraud and abuse?
Healthcare fraud and abuse may be on the rise in light of disbursement of the CARES Act Provider Relief Funds. To be eligible for relief funds, providers must agree to comply with the terms and conditions of the relief funds and maintain proper documentation evidencing how the funds are allocated. Failure to comply with the terms and conditions and/or the misuse of the relief fund payments may result in False Claims Act liability, which includes civil penalties and treble damages.
Based on your experience, what do you predict to be the top three most influential changes?
I find that that the most influential changes post-pandemic are as follows: First, an increase in the use of telehealth services, specifically for behavioral health services and for individuals residing in rural and underserved areas. Second, an improvement in the use of healthcare goods/supplies across states. Third, healthcare facilities and hospital systems will have to re-educate and revamp their internal emergency preparedness protocols and response times. The revamp may include resource allocation and storage, implementation of pop-up hospitals, new operational procedures, and whistleblower protections.