COVID-19 Pandemic Fueled the Growth of Telemedicine in Allergy

Esther Landhuis

November 10, 2021

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The use of telemedicine has historically been low among allergy practitioners compared with other specialists, but the pandemic has accelerated the growth of virtual allergy visits.

"My own practice went from zero to 100% telemedicine in a matter of days," Susan Bailey, MD, an allergist at Fort Worth Allergy and Asthma Associates, in Fort Worth, Texas, and immediate past president of the American Medical Association, said during a plenary session at the American College of Allergy, Asthma, and Immunology (ACAAI) 2021 Annual Meeting, held November 4–8 in New Orleans.

"I think the pandemic really pushed people out of necessity to adopt telehealth, or really decide if it's for them or not, quicker than they might have," said Melinda Rathkopf, MD, director of the Allergy, Asthma and Immunology Center of Alaska, in Anchorage, in an interview with Medscape Medical News before co-moderating a telemedicine session at the conference.

Across medicine, practitioners are seeing 50 to 175 times the number of patients through telehealth than they were before the COVID-19 pandemic, and nearly half of doctors are continuing to use telehealth as the pandemic causes shifts in practice patterns and the delivery of care. These trends are shown in McKinsey survey data that were presented at the ACAAI meeting by Jennifer Shih, MD, allergist-immunologist and assistant professor of pediatrics and internal medicine at Emory University, in Atlanta, Georgia.

Several factors allowed telemedicine to grow. During the pandemic, the US Department of Health and Human Services relaxed the requirement that telehealth delivery be HIPAA compliant. Thus, physicians were able to use Zoom, Skype, Facetime, and other everyday technologies for virtual visits. In addition, the Centers for Medicare & Medicaid Services (CMS) instituted a number of changes to make telehealth more accessible — among them, recognizing a patient's home as an originating site and allowing virtual visits for new patients in addition to established ones.

Before COVID-19, "I could not initiate a telehealth visit with someone I had never met in person for the first time. In Alaska, that included an in-person physical," said Rathkopf. "Those rules were all lifted during the pandemic."

As more practitioners started offering telehealth, 46% of US consumers said they were using telehealth in lieu of canceled healthcare visits, up from 11% in 2019, according to McKinsey data that Shih reported at the meeting. More than three quarters of consumers said they would likely use telehealth after the pandemic.

Of 297 patients who used telehealth services at Emory Allergy Clinic between March 24 and May 29, 2020, 88% of them rated their comfort level on seeing a doctor virtually with the highest score (10 out of 10) on a survey published by Shih and colleagues. Forty percent rated their telehealth visit equivalent or superior to a traditional outpatient encounter. And in a consumer survey conducted by Accenture, 64% of patients said they would change practitioners if they couldn't see the doctor via telehealth.

Given this demand, "it is smart for allergists to continue to offer this service as reimbursements remain after our current public health emergency," said Shih. "For most allergists, it will make most sense as an additive service."

After the pandemic, CMS reimbursement for audio-only visits will not be reimbursable under the current telephone visit or standard E/M codes, except for mental/behavioral health, said allergist Sakina Bajowala, MD, of Kaneland Allergy and Asthma Center, in the Chicago area. However, she noted, digital check-in codes can be used to cover certain audio-only interactions of 5–20 minute duration, Bajowala told Medscape Medical News after presenting at ACAAI. Although audio-only virtual care is currently reimbursed with parity to in-person rates by CMS, she said, rules for individual commercial insurance carriers vary by carrier and state jurisdiction.

As the year draws to a close, allergists should take time to reflect on how they fared with telemedicine in the past year, said Tania Elliott, MD, chair of the ACAAI Telemedicine and Technology Task Force. "What made your workflows easier? More efficient? Better for patients and clinicians?," she asked.

Elliott encourages clinics to rethink current models of brick-and-mortar care delivery. "Does your patient really need to come in every 6–12 weeks for asthma," she said, "or can they come once or twice a year in person and the rest of visits can be done virtually?"

It's clear telemedicine will continue after the pandemic. Some practitioners might completely switch over, "like that might be their niche," said Rathkopf. However, in a virtual visit, "I can't feel if you have a large liver," she said, and in the in-person setting, "I may notice a mole as I pull up your shirt to listen to your lungs. There's definitely no substitute for a good, well-done physical exam."

Bajowala has consulted for Solid Starts, has a speaking/media contract with Novartis, and is part owner of Wise Prince, LLC, which develops digital tools to optimize the safety of food allergen desensitization. Elliott has received speaking fees from Teva Pharmaceuticals. Rathkopf serves as managing partner at AAIC and is on the speaker's bureau for Teva Pharmaceuticals. Shih has disclosed no relevant financial relationships.

American College of Allergy, Asthma, and Immunology (ACAAI) 2021 Annual Meeting: Presented November 7, 2021.

Esther Landhuis is a freelance science journalist in the San Francisco Bay Area. She can be found on Twitter @elandhuis.

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