Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations

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Abstract

The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.

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Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation

Ivy A Lee, Carrie Kovarik Kovarik, Trilokraj Tejasvi … (2020)

To the Editor: Telehealth is an effective, efficient way to triage and deliver timely, quality medical care. In the setting of this public health emergency, telemedicine can maintain access and continuity of care for patients, support colleagues on the front line, optimize in-person services, and minimize infectious transmission of COVID-19 coronavirus. On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a 1135 Waiver and expanded telehealth coverage for all Medicare patients during the COVID-19 pandemic. What does this mean for clinical practitioners? In short, telemedicine can be used for the evaluation and management of most patients. CMS's policy changes effectively eliminate the main barriers to telemedicine implementation: lack of reimbursement, licensing restrictions, and Health Insurance Portability and Accountability Act (HIPAA) compliance (Table I ). Given current Centers for Disease Control and Prevention guidelines, in-person care should be limited to only the most urgent patients. This minimizes risk of COVID-19 transmission and ensures that finite clinical resources will be equitably distributed to those that need it most. Table I Updates in telehealth policy in the COVID-19 crisis∗ , + Pre-COVID-19 telehealth policy∗ COVID-19† Physician licensure Providers must be licensed in state of the patient Waived but state regulations apply. Patient population Established patient of the practice (within 3 years) New or established patients Patient location Eligible originating sitesRural communities (HRSA) All settings, including patient's home. Technology 1 Synchronous (live-interactive)Asynchronous (store & forward) No change. Privacy and security HIPAA compliance Not enforced. Synchronous E-visit (provider to patient) Codes: 99201-99215Only for established patients in eligible originating sites and geographic locations.Place of Service code: POS 02Co-insurance/deductibles apply May be reimbursed at the same amount as in-person visits, when using an interactive audio and video telecommunications system permitting real-time communication between distant site and patient at home.^ Providers have flexibility in reducing/waiving out-of-pocket costs for patients. New or established patientsPlace of Service code: POS 11> Modifier: 95 Modifier: 95 Modifier: 95 Modifier: 95 Practitioners who bill Medicare telehealth services should report POS code that would have been reported had the service been furnished in person.

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National Health Care Spending In 2019: Steady Growth For The Fourth Consecutive Year: Study examines national health care spending for 2019.

Anne Martin, Micah Hartman, David Lassman … (2021)

US health care spending increased 4.6 percent to reach $3.8 trillion in 2019, similar to the rate of growth of 4.7 percent in 2018. The share of the economy devoted to health care spending was 17.7 percent in 2019 compared with 17.6 percent in 2018. In 2019 faster growth in spending for hospital care, physician and clinical services, and retail purchases of prescription drugs-which together accounted for 61 percent of total national health spending-was offset mainly by expenditures for the net cost of health insurance, which were lower because of the suspension of the health insurance tax in 2019.