Using innovative digital technologies and social media as a defining way to keep people connected, safe, productive, and healthy while being physically and socially apart is one of the key lessons learned from the COVID-19 pandemic. For example, telemedicine technology, used in situations where distance
separates patients and providers from engaging in face-to-face encounters, enables virtual facilitation of healthcare interactions between patients and their doctors, allowing them to communicate more frequently and effectively. More than 80% of rural US communities, where over 20% of all Americans live, are medically underserved. Although Telemedicine cannot enable doctors to conduct physical exams, it does help these families and their children with basic medical care, health oversight, second opinion consults, and mental health counseling.
Prior to March 2020, healthcare providers who desired to use Telemedicine were stymied by inadequate reimbursement for time and service. Regulations mandated that patients and their providers, in order to engage in the use of Telemedicine, had to be located in the state where the physician was licensed to practice at the time of treatment. Related issues about what type of technology interface could be used to ensure that privacy regulations were observed was another barrier. Regulations on the filling of prescriptions posed another set of problems. During the pandemic, these restrictions were waived, and CMS reimbursed medical practitioners for telemedicine visits no matter where they were needed, without consideration of where the medical practice resided. As a result, Telemedicine has thrived, along with remote patient monitoring. Versions of commonly used platforms like Zoom and Google Meet were also allowed.
As the pandemic became less of a threat to public health, there has been a push to continue Telemedicine, in part. Telemedicine eliminates barriers placed on patient healthcare access, such as specialty care, monitoring of chronic disease, and educating patients about pre-surgical preparation and post-procedure follow-up.
David Entwistle, President and CEO of Stanford Health Care, analyzes the telemedicine challenge in an article in the Stanford Education News. He writes, “While the rapid jump to telehealth was sometimes hard to manage, virtual visits spiked in Stanford from 2% to more than 70% at its peak. Its popularity has not waned. “Technology,” he said, “has allowed us to be able to meet demand for care in a new way. It has allowed us to see more patients and to see them more frequently,” he said
https://med.stanford.edu/news/all-news/2021/11/pandemic-puzzle-innovation-technology.html
Post-COVID, access to telemedicine services has become somewhat more extensive in some places and less in others, with the increased awareness of its benefits. Under current regulations, Federal Qualified Health Centers and Rural Health Clinics can continue to provide telehealth services to patients wherever they are located — including in their homes through December 31, 2024. This includes coverage for specific audio-only telephone evaluation and management services.
Unfortunately, the regulations regarding Telemedicine are not universal. Some, but not all, patient categories, such as Medicare beneficiaries, privately insured individuals, and Medicaid recipients, are eligible for a wider range of services than before. Others will lose access completely. It is important for patients to check their specific insurance plan, state regulations, and provider availability to ensure eligibility for the services they would like to continue.
The general qualifications for Medicare Beneficiaries to use Telemedicine are as follows:
Permanent Medicare changes
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as distant site providers for behavioral/mental telehealth services.
- Medicare patients can receive telehealth services for behavioral/mental health care in their homes.
- There are no geographic restrictions for the originating site for behavioral/mental telehealth services.
- Behavioral/mental telehealth services can be delivered using audio-only communication platforms.
- Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth.
Sources: Consolidated Appropriations Act, 2021 (PDF), Consolidated Appropriations Act, 2022 (PDF), CMS CY 2022 Physician Fee Schedule (PDF), CMS CY 2023 Physician Fee Schedule (PDF)
Temporary Changes (through December 31, 2024):
- No Geographic Restrictions: Patients can receive telehealth services from anywhere in the US, regardless of their or the provider’s. Location.
- Patients can receive non-mental telehealth services in their homes.
- Certain non-mental telehealth services can be delivered using audio-only communication.
- There is no In-person Visit Requirement for behavioral/mental health. The in-person visit requirement within six months and annually thereafter has been temporarily waived.
- Private Insurance: Coverage varies depending on your specific plan and state regulations. However, many insurers have expanded telehealth coverage post-COVID.
- Medicaid: Coverage varies by state, but most states now cover a broad range of telehealth services.
- There must be certain equipment available, including access to a device with an internet connection and appropriate software/apps to participate in telehealth appointments.
Source: Consolidated Appropriations Act, 2023 (PDF)
There also are many new innovations, post – COVID that will add great value to telehealth. Pocket-size ultrasound devices that cost 50 times less than the machines in hospitals (and connect to a patient’s mobile phone, as well as apps that measure blood pressure, In-pulse heart rate, oxygen level, blood sugar, apps that provide healthy diets along with tracking and other apps that outline healthy habits and fitness programs are also now available.
In conclusion, Telemedicine is now proven, and its benefits are obvious, particularly to those patients living in underserved communities. Virtual consultations will shorten wait times and improve patient satisfaction, particularly for managing follow-up visits, chronic conditions, and non-emergency concerns. These consultations are also a useful tool to close the gap between hospital discharge and outpatient care, providing ongoing support and monitoring to prevent complications and hospital readmissions. Telemedicine visits improve continuity of care and are also critical in the mental health sphere.
Teletherapy offers convenient and confidential access to mental health services, reducing stigma and encouraging individuals to seek help. Telemedicine can be used for initial consultations and triage of patients with potentially infectious diseases, reducing the risk of transmission in healthcare settings and promoting public health safety. It offers public health benefits, such as lowering the overall cost of care by reducing unnecessary emergency room visits, hospital admissions, and travel expenses.
