In brief, the article discusses:
- The future of medicine is online
- How telemedicine broadens access to healthcare for many people
- Medicare/Medicaid coverage of telemedicine
- Virtual visits mean better care for the patient
The full article is reproduced below.
Ushered In By COVID-19, Virtual Visits Are Here To Stay
Access, convenience, and safety are all major benefits of telemedicine services.
Suddenly, we’re conducting business meetings, attending classes, and hosting happy hours on our mobile phones and laptops via video conferencing apps rather than gathering in person.
And it seems the future of medicine, too, may be online. That’s because more doctors and hospitals are providing health care to patients via electronic devices in an effort to keep people healthy while protecting them from exposure to the novel and deadly coronavirus. The coronavirus pandemic forced people away from crowds—including the waiting room at their doctors’ offices—and into their homes to help stop the spread. The need for social distancing accelerated the need for touchless health care, and technology has made it easier than ever.
But social distancing isn’t the only benefit to telemedicine—it’s also expected to broaden access to health care for many people, including more convenient appointment times, easier access to far-away physicians, and faster follow-up visits without long or difficult commutes.
“We were moving to telemedicine without a pandemic,” explains Dr. Martin Doerfler, senior vice president of Clinical Strategy and Development for Northwell Health. “It’s the next step in building better, stronger partnerships between the patient and provider.”
What is telemedicine?
The Centers for Medicare & Medicaid Services (CMS) defines telemedicine, or telehealth, as the exchange of medical information through electronic communication to improve patient health. Before now, most telemedicine consisted of primary care physicians consulting with specialists, sometimes at distant locations otherwise inaccessible by their patients, and sharing information. Now, it increasingly includes patients having real-time video chats with a doctor or other health care provider.
But many telemedicine services were not widely available even at the start of this year. CMS had complex requirements for telemedicine services for Medicare patients before it covered them, including requiring that a patient be at a doctor’s office, hospital, rural health clinic, skilled nursing facility, or a handful of other approved health care sites when receiving care via telemedicine. One place the patient could not be, though, was at home.
State laws governing payment for telemedicine services provided to Medicaid recipients often did not require reimbursing physicians and other health care providers at the same rate as those providing care in person, even though it’s no less work. Commercial insurers often follow the CMS’s lead on payment and are also bound by their state’s coverage laws, leading to limited access to telemedicine services for the privately insured as well. Altogether, despite the availability of high-quality telemedicine equipment, computers, and electronic medical records, providing telemedicine services proved difficult or unfeasible for many doctors and health care facilities.
Then the COVID-19 pandemic changed everything.
In March, the CMS eliminated the biggest hurdle to widespread telemedicine adoption when it declared it would pay health care providers for telemedicine services given to Medicare beneficiaries anywhere in the country, including in their own homes, for the duration of the coronavirus crisis. The goal, CMS explained, was to ensure that people had easy access to necessary health services while also maintaining social distance to contain the spread of the coronavirus.
But many doctors and hospitals couldn’t just offer those services overnight. Organizations like Northwell Health have been building the infrastructure and providing the training to scale these services for years; the eICU program launched in 2014 now covers 13 ICUs at 11 of Northwell’s 23 hospitals and treats 160 patients daily, cutting mortality rates by 20%.
Increased access, convenience
Consider people without their own vehicles who also live in areas where public transportation is limited, Doerfler says. On Long Island, for example, public transportation from the east to west is widely available, but not so from north to south. “Think of a parent who has to take two buses and an Uber just to get their child to a pediatrician,” he explains. “This seriously impacts the lives of individuals in communities with less access.”
Telemedicine presents another opportunity for patients to have face-to-face conversations with their doctors about their medical history and current concerns, without spending hours just arriving for an appointment, Doerfler explains. It can allow doctors to check in with people at their bedside in places such as skilled nursing facilities, rather than requiring them to endure an unnecessary ambulance ride to the emergency room only to be seen by a doctor who is unfamiliar with them. Patients who just had surgery or were recently released from the hospital could be seen by their doctor in a few days, rather than waiting for a week for an in-person visit.
“If you can identify and resolve those issues earlier, you can spare a patient significant health decline or readmission to the hospital,” Doerfler explains. “It’s better care for the patient.”
Increased access to telemedicine, though, does not mean doctors will replace all in-person visits with video chats. “If a patient needs to be seen in the office, they’ll be brought into the office,” Doerfler says—whether for serious matters, necessary lab tests, or simple patient preference. But for patients who do not need or want to be seen in person, a virtual visit can be beneficial. Imagine being able to schedule weekend visits with your physician or avoiding the need to travel long-distance and sit in a waiting room for your regular follow-up visit that normally only lasts five minutes.
“The future,” Doerfler says, “is any patient, anywhere, with any provider.”
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