While telemedicine has certainly been around for a long time, it has recently been magnified by the Covid-19 global pandemic. Unfortunately, telemedicine was an underutilized service that was difficult for providers to use effectively. There were problems with treatment and appropriate billing practices.
Once the pandemic forced critical services to go online, telemedicine has experienced rapid growth, use, and technology improvements. As the number of Covid-19 vaccinations continues to climb and life begins to return to some semblance of normal, it is important to understand what role telemedicine can play for your practice and patient access.
It is important to understand a basic history of telemedicine in the context of a global backdrop. As the saying goes, "History repeats itself," and identifying past trends can be used as a tool to identify future behavior.
Some early societies also used smoke signals to warn their distant neighbors about health issues and allow them to keep some physical distance to protect themselves. One of the first uses of the telegraph was during the Civil War that allowed field hospitals to convey information about casualties, injuries and call for specific medical supplies. In the 1950s, the Nebraska Psychiatric Institute used television to conduct videoconferences and telepsychiatry for their patients.
As technology has improved, telemedicine has been able to utilize those services to increase access and care for patients. More than 90% of Americans use the internet, and more than 80% of Americans use smartphones. Yet, widespread use is limited by regulations and other market access conditions.
While many providers use the terms "telemedicine" and "telehealth" interchangeably, there are differences between them. Telemedicine is considered a service that permits two-way, real-time communication between patients and their medical team. In contrast, telehealth uses telecommunications and technology to provide access to assessments, diagnoses, interventions, consultations, and supervision of patients. This suggests that telehealth is a broader concept of telemedicine that includes remote patient monitoring (RPM).
Even before Covid-19, telemedicine was becoming an increasingly popular method of communicating with patients. In 2010, hospitals in the United States utilized video and other technology about 35% of the time. By 2017, that use was up to 76%. Additionally, just between 2016 and 2017, telemedicine insurance claims increased by 53%. Researchers believe that the increase in the use of telemedicine influenced its efficacy during the pandemic.
Each state within the United States has varying laws that prohibit a unified national approach to telemedicine. This issue can make it particularly difficult when patients and companies are working with Medicare or Medicaid and operate in different states.
The United States utilizes telemedicine at significantly higher rates than the E.U., Korea, and Japan.
While telemedicine has been increasing in use before the current global pandemic, its use has rapidly increased and changed. While many patients have been required to maintain strict quarantine, many facilities started to use telemedicine as a means for triaging patients for their facility's availability. This approach has successfully allowed hospitals and other service providers to meet increased demand through changes in scheduling staff, hiring, moving patients to new facilities, and scheduling facility equipment.
This global pandemic has created new methods and utilization of telemedicine that were not previously available. In particular, one point that has emerged from the pandemic is the use of automated logic flows or bots. This approach allows for the referral of moderate and high-risk patients into designated triage phone or video lines where nurses can provide medical care and avoid physical contact, thus reducing the potential for disease transmission.
However, it hasn't been all positive messages that have emerged about the use of telemedicine. The increased utilization of telemedicine has also identified a patient preference for using a digital platform or receiving treatment from somebody other than their normal provider. Technological barriers also exist, specifically with geriatric populations where education about telemedicine and the specific use of digital devices has increased frustrations.
Several other issues currently exist with telemedicine, such as the lack of physical contact. This means that physicians cannot complete many physical or baseline tests, such as blood pressure, chest and lung sounds, abdominal obstructions, to name a few.
During the pandemic, CMS responded by extending payment parity to telemedicine visits. Questions remain as to whether and how it will continue when the pandemic ends. Private payors tend to follow CMS guidelines subject to their utilization goals.
Even though CMS has expanded telemedicine's role, the states can still create their policies regarding Medicaid. This includes the ability to not allow telemedicine or limit the services offered.
Final regulations will depend on cost-benefit analysis to the society as a whole. Also, its impact on the healthcare workforce and infrastructure including economic ramifications for providers will influence regulations.
Even in advance of the COVID-19 pandemic, there was an ability to communicate with patients with computers and smartphones 24/7. This included video, text, email, phone, and even wearable devices such as activity trackers. In addition, Medicare and Medicaid have now incorporated the costs of technical fees into their structure.
The increased demand and reliance on telemedicine have led to better dependability, cost reductions, video call quality improvements, and more awareness during the pandemic. These factors combine to create a better experience for end-users of the technology, and practitioners can help their patients achieve better health-related outcomes.
In addition to the increases in technology, telemedicine offers many patients and their providers further benefits. These include reducing costs for travel, cleaning and maintaining waiting areas, and reduced travel and wait times for patients. These factors have special importance when considering some of the areas where transportation costs have typically been considerably higher. Specialized areas include radiology, psychiatry, home health, and even patients currently in jail or prison.
One demographic of the population that stands to disproportionately benefit from telemedicine are those in rural communities. Approximately 20% of the population lives in areas that are considered rural. While most of these individuals also have health insurance, 26% believe they lack appropriate healthcare access. Additionally, approximately 8% of rural Americans have experienced a hospital closure in their local community.
However, while these rural patients lack physical access to healthcare, more than 85% use the internet, and around 71% of rural adults own a smartphone. The ability to quickly and seamlessly transition these individuals to see qualified medical professionals is already in place. Additionally, in some communities, special facilities are set up that have the equipment and technology already available for use. Rural communities can use these hubs to pick up prescriptions and even speak privately with their pharmacist without ever leaving their home area.
Telemedicine is an approach that may have seemed out of reach for many practices in advance of COVID-19.
While it is impossible to predict the future, many medical professionals and societies believe that providers will not only continue to use telehealth, but there will be increases in its use after COVID-19. The AMA has even suggested that they see practices moving away from a “Blockbuster model” where patients must visit a specific location to receive their services. They are now moving towards a “Netflix model” where patients can receive services within the comfort of their own home or care facility. That means that medical practices that have not yet transitioned to utilizing telemedicine in their practices risk isolating many potential patients.
However, if Medicare payments and reimbursements remain in place, Congress will need to ensure that these methods remain permanent. While both Democrats and Republicans have shown willingness to work together to pass legislation, it is still a potential point of contention. Congress must wrestle with some of the issues surrounding patient privacy, reimbursement, and even the potential higher costs of maintaining a telehealth system, even while it lowers costs for the individual user.
If public opinion weighs in on the movement of Congress, we should expect federal legislation to pass easily. A recent survey completed by Sykes found that in March 2021 that 88% of their respondents wanted telehealth to continue to be an option to receive non-urgent healthcare. Additionally, more than 80% of the respondents believe it was possible to receive quality care through an online platform.
Telemedicine appointments in the future are likely to be considered an option for many practitioners, but not every field of medicine can benefit from telemedicine. Experts believe that telemedicine continues to be an option for acute, non-urgent medical care, behavioral health, and pharmacology. For some specialties, it may be critical that they continue to offer telemedicine appointments, while it could be a convenience for other practices.
Types of visits that could continue in the future include triaging calls, follow-up appointments, stable chronic conditions, behavioral health visits. They will also be subject to payor utilization management protocols.
While even the current standard of technology is adequate for most practitioners to utilize telemedicine effectively, we're likely to see more advances in the near future. If you've been considering utilizing telemedicine and or remote patient monitoring (RPM) in your practice but have been hesitant, there has never been a better time to make the change.