Push for Telemedicine Advances During the COVID-19 Pandemic
During the COVID-19 public health emergency, the use of telehealth services has skyrocketed, especially among at-risk seniors and patients located in rural areas with limited access to health care. In recent months, telemedicine has proven to be an effective and cost-efficient way to deliver care to patients — and government officials have taken notice. If your company's health insurance plan does not already offer telemedicine options to workers, it is time to consider adding it. If you do offer telehealth services, encourage employees to choose this option over traditional in-person appointments for preventive and other nonessential visits.
Expansion of Virtual Health Care
Telemedicine offers numerous benefits over traditional, in-person health care delivery methods. In-person doctors' appointments can be time-consuming and expensive. Plus, in-person visits may contribute to the spread of disease: Patients with compromised immune systems may be exposed to other germs in the doctor's office, possibly leading to secondary infections. And health care workers (including doctors, nurses, and receptionists) may be exposed to whatever germs their patients are carrying. This is one of the reasons that in-person visits and nonessential surgeries were postponed while COVID-19-related shelter-in-place orders were in effect.
While limits were imposed on in-person visits, people turned to telemedicine for their health care needs. Virtual visits for Medicare beneficiaries jumped from approximately 14,000 per week before the public health emergency to almost 1.7 million in the last week of April, according to statistics published by the White House.
Additionally, a recent report by U.S. Department of Health and Human Services (HHS) shows that 43.5% of Medicare fee-for-service primary care visits were provided through telehealth in April, compared with 0.1% in February before the public health emergency.
Currently, many health care providers have lifted their bans on elective medical procedures and in-person appointments. But many patients are continuing to choose telemedicine over in-person visits. This suggests that the expansion of telehealth services will continue to be a critical feature of the healthcare delivery system, even beyond the pandemic.
Obstacles to Adopting Telemedicine
The pandemic has helped telemedicine to overcome major obstacles to its broad acceptance. Historically, patients and medical professionals have been reluctant to try something new, and some feared that telemedicine would compromise the quality of care.
During the early days of the pandemic, however, telemedicine was the only option for most patients who needed nonemergency care. Many patients were satisfied with the results of their telehealth visits, reporting that their concerns were resolved effectively, at a lower cost and more quickly than their previous experiences with in-person care.
In March, Vice President Pence met with executives of major private health insurance companies. These insurers agreed to cover telemedicine for patients for any reason for the next few months — no matter the reason for seeking medical treatment. The insurance representatives attending the meeting also agreed to cover COVID-19 treatment and waive copayment fees for COVID-19 testing. (Those agreements were only temporary, however, and in some cases, patients have still received bills for these services.)
Likewise, during a White House press conference on March 17, it was announced that Medicare would temporarily offer a wide range of services via telemedicine. These measures were designed to keep sick and at-risk patients at home, encourage testing for COVID-19, make treatment more affordable, and potentially reduce the severity and duration of the outbreak.
However, the pandemic has not fully resolved the matter of how hospitals and medical providers are reimbursed for telemedicine services over the long run.
On August 3, President Trump issued his "Executive Order on Improving Rural and Telehealth Access." It instructs the Centers for Medicare and Medicaid Services (CMS) to take steps to extend the availability of certain telemedicine services after the public health emergency ends. This will give Medicare beneficiaries more convenient ways to access healthcare, particularly in rural areas where access to health care providers may otherwise be limited.
"Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America's seniors," said CMS Administrator Seema Verma. "The Trump Administration's unprecedented expansion of telemedicine during the pandemic represents a revolution in [health care] delivery, one to which the [health care] system has adapted quickly and effectively."
The executive order noted that 129 rural hospitals have closed over the last decade due to declining patient populations. Telemedicine can provide a lifeline to surviving rural hospitals and the people they serve beyond the COVID-19 pandemic.
The President's executive order doesn't guarantee that the expanded telehealth benefits for Medicare and Medicaid beneficiaries will be permanent, however. That will require federal legislation.
Congressional Action Needed
Prior to Trump's executive order, Congress had introduced legislation that would provide the legal authority for more fundamental, permanent changes in Medicare's telemedicine reimbursement policy. Specifically, the Protecting Access to Post COVID-19 Telehealth Act of 2020 would:
· Remove geographic restrictions on where a patient must be located in order to utilize telehealth services,
· Enable patients to continue to receive telehealth services in their homes, and
· Establish "permanent waiver authority" for the HHS during future emergency periods.
The bill has been endorsed by over three dozen organizations, including the American Academy of Physicians and other medical organizations serving medical specialists in the areas or cardiology, diabetes, psychology, urology, and pharmacology.
More Barriers to Consider
Most regulation of medical practices occurs at the state level. But telemedicine allows people to use practitioners outside of their geographic locations, possibly even across state lines. So, state licensure laws are a major barrier to interstate telehealth expansion.
In addition, some large health insurance companies do not see eye-to-eye with physicians on how much they should be paid for telemedicine-based office visits. From the physician's perspective, the value of their time spent with a patient is not affected by the mode of communication. Some insurers, however, pay less for telehealth visits than for in-person appointments.
The CDC also acknowledges that telemedicine has limitations. "There are some situations in which in-person visits are more appropriate due to urgency, a person's underlying health conditions, or the fact that a physical exam or laboratory testing is needed for medical decision-making," says the CDC.
Future of Health Care Delivery
While advocates agree that telemedicine is not appropriate in all situations, they do see significant opportunity for growth. In any case, the rapidly evolving telemedicine landscape warrants the attention of employers as they work with their health care plan providers and consultants to find the best strategies to deliver high quality care to their employees as affordably as possible.