When COVID-19 spread to the US in early 2020, the country’s telehealth infrastructure entered a fire process.
It was of the utmost importance for hospitals to minimize personal care – not just to limit the spread of the virus, but also to ensure that hospitals are not overwhelmed as they are in Italy. This is a major reason Medicare and most private insurers tried to improve access to telemedicine in March by easing restrictions, waiving fees, and reimbursing doctors for virtual visits at the same price as in-person visits.
Shortly after these temporary measures were in place, telemedicine visits skyrocketed. For example, a U.S. Department of Health report found that about 43 percent of home calls were made through telemedicine in April, compared with just 0.1 percent in February.
How did this change go? Although they only had a few weeks to prepare, most U.S. health organizations managed to massively increase their virtual case numbers with amazing ease. Dr. Martin Doerfler, Senior Vice President of Clinical Strategy and Development at Northwell Health, was one of thousands of health professionals who saw the transition.
“We went from the proverbial ‘zero to 60’ within a few weeks and provided good care with very high patient satisfaction,” says Dörfler.
Before the pandemic, Northwell Health – the largest hospital system in New York – was making about 150 telemedicine visits per month to between 20 and 40 doctors. But in May alone, Northwell had made about 65,000 visits to about 8,000 health professionals across the health system.
As an example, Doerfler cited a single mother whose toddler had chronic illnesses, including respiratory diseases, which made personal visits particularly dangerous during the pandemic. The pediatrician was able to assess the child, speak to the mother via a telemedical translation service, and provide the family with the necessary steps to keep the child healthy. The mother gladly refrained from having to take her child to a personal hospital visit by public transport and still receive the necessary care.
Three hours for 200 miles is no different than three hours for two trains, two buses, and a taxi.
Clinicians at Northwell have used telemedicine to adapt to the pandemic in a variety of ways, from posting phlebotomists after virtual visits to elderly patient homes, to connecting fresh mothers with lactation specialists via secure, encrypted telemedicine channels.
“There are all sorts of examples across health care where this technology, and the willingness of patients and clinicians to embrace it, enables the treatment of problems that are normally done face-to-face,” Doerfler said.
Telehealth programs that existed before the pandemic also helped protect both patients and hospital staff by reducing in-person visits to a minimum. For example, Northwell’s TelePsychiatry Department connects people in crisis who typically go to the emergency room to a behavioral medicine specialist in about 45 minutes any time of the day or week. This is a significant improvement as the emergency room staff typically doesn’t include psychiatrists or other specialists who can help someone experiencing a behavioral emergency.
The success of telemedicine during the pandemic begs the question: Why hasn’t US healthcare already embraced virtual care?
One of the major obstacles to the widespread adoption of telemedicine has been the lack of national legislation giving health centers a financial incentive to adopt.
State laws differ in how doctors are paid for telemedicine visits. Some states require insurance providers to cover telemedicine visits in equal parts as in-person visits. But in countries without parity laws, there is little incentive for health organizations to invest in telemedicine infrastructure and training.
Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally only reimburse physicians for telemedicine visits if patients live in “designated rural underserved areas.”
But not all underserved areas are in small, remote locations. Finally, a single parent who lives in Brooklyn, New York, may also have difficulty accessing quality health care.
“Three hours for 200 miles are no different than three hours for two trains, two buses and a taxi,” said Dörfler. “So access will almost certainly be improved by the greater availability of telemedicine in this environment directly at the patient’s, at home or in the office.”
The lack of internet access is also a problem. A paper published by the JAMA Network in August found that 41 percent of Medicare beneficiaries do not have a home computer with high-speed Internet access and roughly the same number do not have a smartphone with an unlimited data plan.
Photo credit: Daniilvolkov via AdobeStock
Both party lawmakers and health professionals have expressed a desire to make some of the regulatory changes to telemedicine enacted during the pandemic permanent. This is crucial because without the financial incentives to further expand telemedicine, healthcare providers could revert to the pre-pandemic approach.
“A major issue for healthcare and non-healthcare professionals is that telemedicine will continue to grow dramatically as long as it is funded and reimbursed,” said Michael Dowling, President and CEO of Northwell. “If the insurance companies and the government decide, ‘We don’t want to pay for telemedicine or virtual visits in the future,’ then things will slow down. If there is no delivery system, no health system, no hospital or no doctor will continue to develop telemedicine if they do not receive any reimbursement. “
However, some of the country’s largest insurers have already stopped waiving telemedicine deductibles and co-payments for some customers, although there is no clear end to the pandemic in sight.
The long-term solution, Doerfler said, is for CMS to start paying up and down equally for telehealth services and passing federal laws requiring self-insured health insurance plans to pay for telehealth services like they would. Person visits.
Telemedicine has been shown to work for emergency care, basic care and some special treatments and, according to Doerfler, significantly expands access to behavioral health care. “Some have said that the cost of providing telemedicine is lower than providing personal care, but most costs remain the same and new ones are added as technology demands. When the patient is receiving a specific service, billing codes are used to define that service. When the service is less, the code represents that. If the service is the same, the code represents this and must be paid equally. “
Doerfler added that while telemedicine cannot replace all traditional health services, it should be “in the toolbox” for patients and doctors.
“In the modern world, where this type of technology is used for all kinds of personal and business purposes, there is no point in excluding something as personal as your care between you and your doctor from adapting to this modern paradigm,” said Dörfler .