Early Use of Telehealth in Home Dialysis during the COVID-19 Pandemic in New York City.

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic is forcing unprecedented changes in daily life in the United States. During this time, many patients are under “lockdown” or “shelter-in-place” orders, and the nephrology community has been forced to adapt quickly to this new reality. New York City is the epicenter of the American outbreak, and patients on dialysis are at especially high risk of COVID-19 exposure due to widespread use of public transportation and densely packed clinical spaces. Here, we report the early use and success of using telehealth visits in place of usual in-person monthly comprehensive visits in an effort to provide excellent patient care while limiting the risk of patient and staff exposure to COVID-19. Telehealth has distinct advantages during this crisis for the vulnerable home dialysis population; however, many practical challenges remain. Under the 2018 Bipartisan Budget Act, the Centers for Medicare & Medicaid Services (CMS) allowed patients on home dialysis to choose to have their monthly ESKD clinical assessments through telehealth. However, restrictions have remained, and the use of telehealth was only available after completing in-person visits for the first 3 months of home dialysis; additionally, only two of three monthly visits each quarter were eligible for telehealth thereafter (1). On March 20, 2020, the CMS released a telemedicine and telehealth toolkit for ESKD providers to help providers establish and operate a telehealth program to increase access to health care for patients at home and especially patients on dialysis who are at significant risk of morbidity and mortality if infected by COVID-19 (2). As of March 27, 2020, New York City has over 25,000 cases of COVID-19, with the number rising each day (3). The Rogosin Institute is an independent dialysis provider affiliated with New York-Presbyterian Hospital with a home dialysis population of 210 patients: …