HIV Specialist - March 2021 - 15

That stated, there is growing evidence that technology skills and
access have never been better. Among all U.S. households in 2016,
89 percent had a computer and/or smartphone, and 81 percent had a
broadband internet subscription.9 Although we have not completely
bridged the digital divide, we are certainly moving in a direction that
is favorable for the successful implementation of telehealth services
for individuals and communities struggling with HIV.

Funding High-Value Care

Although the value of telehealth services for individuals with chronic
conditions, such as HIV, is considered to be high, insurance reimbursement for such services has varied.
The HRSA Ryan White HIV/AIDS Program has been promoting the
expansion of HIV care through telehealth since before the pandemic.10
However, the COVID-19 pandemic has driven more rapid changes in
reimbursement for telehealth services. The Centers for Medicare &
Medicaid Services (CMS) has broadened access to Medicare telehealth
services so that beneficiaries can receive a wider range of services from
their doctors without having to travel to a healthcare facility.11
Under an expanded new 1135 waiver, beginning March 6, 2020 and
for the duration of the COVID-19 public health emergency, Medicare
will reimburse for office, hospital, and other visits furnished via
telehealth across the country. A range of providers, including doctors,
nurse practitioners, clinical psychologists, and licensed clinical social
workers, are able to offer telehealth to their patients. Additionally,
the HHS Office of Inspector General (OIG) is providing flexibility
for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. Prior to this waiver
Medicare could only pay for telehealth on a limited basis when the
person receiving the service was in a designated rural area and when
they would leave their homes and go to a clinic, hospital, or certain
other types of medical facilities for the service.
Even before the availability of this waiver authority, CMS made
several related changes to improve access to virtual care. In 2019,
Medicare started making payments for brief communications or
Virtual Check-Ins, which are short patient-initiated communications with a healthcare practitioner. Medicare Part B separately pays
clinicians for E-visits, which are non-face-to-face patient-initiated
communications through an online patient portal.
Medicare beneficiaries are able to receive a specific set of services
through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health
screenings. This will help ensure Medicare beneficiaries, who are at
a higher risk for COVID-19, are able to visit with their providers from
their homes, without having to go to an office, clinic or hospital, which
may put them and others at increased risk.

Staying Together While Apart

" Stay safe Dr. Joe! " At the conclusion of each telehealth visit, my
patients and I exchange kind words and virtual hugs. Although
we look forward to the end of the COVID-19 pandemic and with it
greater opportunities to exchange these in person, we acknowledge
with gratitude the critical contributions that telehealth has made in

filling otherwise unmet healthcare needs.
It remains to be seen what elements of telehealth will remain as the public health crisis
posed by COVID-19 is perceived to subside.
What appears certain is that as we continue
to address the ongoing pandemic of HIV,
telehealth will continue to afford us valuable
opportunities for staying together while
apart. HIV
JOSEPH S. CERVIA, MD, MBA,
FACP, FAAP, FIDSA, AAHIVS is an
Infectious Diseases physician,
Professor of Medicine and Pediatrics
at the Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell, Senior
Medical Director at HealthCare Partners, IPA &
MSO, Board Member of the NY/NJ Chapter of the
American Academy of HIV Medicine, and Editorial
Advisory Board Member for HIV Specialist.
REFERENCES:
1. HealthIT. " What is Telehealth? " https://www.healthit.gov/
faq/what-telehealth-how-telehealth-differenttelemedicine . Accessed December 29, 2020.
2. Koonin, LM. Hoots, B. Tsang, CA. et al. " Trends in the Use
of Telehealth During the Emergence of the COVID-19
Pandemic-United States, January-March 2020. "
Morbidity and Mortality Weekly Reports. October 30,
2020.69(43);1595-1599. https://www.cdc.gov/mmwr/
volumes/69/wr/mm6943a3.htm#:~:text=During%20
the%20first%20quarter%20of,the%20same%20period%20
in%202019. Accessed December 29, 2020.
3. HRSA. " HIV/AIDS in Rural America. " https://www.hrsa.
gov/enews/past-issues/2017/february-16/hiv-aids-inrural-america.html. Accessed December 29, 2020.
4. AAHIVM. " HIV Care Providers Identify the Top Barriers to
Ending the Epidemic. " https://aahivm.org/2019/12/10/
hiv-care-providers-identify-the-top-barriers-to-endingthe-epidemic/ . Accessed December 29, 2020.
5. Federation of State Medical Boards. " U.S. States and
Territories Modifying Requirements for Telehealth in
Response to COVID-19. " https://www.fsmb.org/siteassets/
advocacy/pdf/states-waiving-licensure-requirements-fortelehealth-in-response-to-covid-19.pdf . Accessed January
4, 2021.
6. AHRQ. Telehealth and Health Disparities. https://www.
ahrq.gov/patient-safety/reports/issue-briefs/teledx-5.
html. Accessed December 29, 2020.
7. Wood, BR. Young, JD. Abdel-Massih, RC. et al. " Advancing
Digital Health Equity: A Policy Paper of the Infectious
Diseases Society of America and the HIV Medicine
Association. " Clin Infect Dis. 2020 Oct 9;ciaa1525. doi:
10.1093/cid/ciaa1525.
8. Dandachi, D., C. Lee, R. O. Morgan, et al. 2019. " Integration
of Telehealth Services in the Healthcare System: With
Emphasis on the Experience of Patients Living with HIV. " J
Investig Med 67 (5): 815-20. doi:10.1136/jim-2018-000872.
9. United States Census Bureau. " Computer and Internet Use
in the United States: 2016. " https://www.census.gov/
content/dam/Census/library/publications/2018/acs/
ACS-39.pdf? . Accessed December 29, 2020.
10. HRSA. " Expanding HIV Care Through Telehealth. "
11. https://hab.hrsa.gov/sites/default/files/hab/Publications/
careactionnewsletter/telehealth.pdf Accessed December
29, 2020.

WWW.AAHIVM.ORG HIVSPECIALIST MARCH 2021

https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm#:~:text=During%20the%20first%20quarter%20of,the%20same%20period%20in%202019 https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm#:~:text=During%20the%20first%20quarter%20of,the%20same%20period%20in%202019 https://www.hrsa.gov/enews/past-issues/2017/february-16/hiv-aids-inrural-america.html https://www.hrsa.gov/enews/past-issues/2017/february-16/hiv-aids-inrural-america.html https://aahivm.org/2019/12/10/hiv-care-providers-identify-the-top-barriers-to-ending-the-epidemic/ https://aahivm.org/2019/12/10/hiv-care-providers-identify-the-top-barriers-to-ending-the-epidemic/ https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf https://www.ahrq.gov/patient-safety/reports/issue-briefs/teledx-5.html https://www.ahrq.gov/patient-safety/reports/issue-briefs/teledx-5.html https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-39.pdf? https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-39.pdf? https://hab.hrsa.gov/sites/default/files/hab/Publications/careactionnewsletter/telehealth.pdf http://WWW.AAHIVM.ORG

HIV Specialist - March 2021

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