Although telemedicine has recently been thrust into the spotlight as one solution to mitigating the strain on healthcare systems due to the global COVID-19 pandemic, telemedicine has been in use since the early 1960s. The slow progression then seemingly overnight explosion of the use of telemedicine as a viable diagnostic and treatment option can be explained by looking into the barriers that telemedicine programs have faced historically as well as the realization of the benefits brought on by the onset of COVID-19.
THE RISE OF TELEMEDICINE
In the early stages of telemedicine, many physicians as well as patients were accustomed to in-person visits which provided the feeling of a more complete medical assessment. Some physicians felt visits made solely through telemedicine increased the odds that conditions might be overlooked that would have otherwise been noticed in a hands-on exam. Some physicians held to the idea that actual in-person visits led to a lower chance of misdiagnosis. Additionally, patients and physicians alike were reluctant to embrace telemedicine since it removed the act of human touch and interaction which historically had been the core behind the practice of medicine.
Initially, the cost of purchasing the necessary technological equipment was another significant barrier to implementation of telemedicine programs for many healthcare systems and clinicians. However, with the Medicare and Medicaid EHR Incentive payments assisting in the purchase of Electronic Health Records (EHR), telemedicine equipment became more attainable. With financial barriers being somewhat decreased, having a unified electronic health record system quickly gained favor among clinicians since it allowed professionals to share data quickly across health systems. The availability of telemedicine equipment and related services also enabled facilities to have access to specialists that they might otherwise not have access to which enhanced patient care.
MEDICARE AND MEDICAID COVERAGE CHANGES
Established rules regarding reimbursement by Medicare and Medicaid produced another barrier to telemedicine programs that served as one of the primary factors in slowing the growth of telemedicine services. However, with the arrival of COVID-19 and the resulting array of temporary regulatory waivers issued by the Trump Administration, financial barriers have decreased as a result of significant coverage expansions by both Centers for Medicare & Medicaid Services (CMS) and commercial payers for the duration of the global pandemic emergency. CMS waived additional regulatory requirements and further expanded telehealth in an interim final rule released on April 30, 2020. Although this is not a complete list, some of the key changes include:
- CMS increased payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits;
- Medicare will pay physicians for telehealth services at the same rate as in person visits for all diagnoses, not just services related to COVID-19;
- Physicians can offer telehealth services to both new and established patients because CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth;
- Patients can receive telehealth services in all areas of the country and in all settings, including at their home;
- Physicians licensed in one state can provide services to Medicare beneficiaries in another state (state licensure laws still apply); and
- Physicians can provide telehealth services from their home. Physicians do not have to add their home to their Medicare enrollment file.
These changes will be paramount in reducing the barriers regarding reimbursement by Medicare and Medicaid.
As the barriers mentioned above are eroding, many healthcare facilities and clinicians are beginning to recognize the benefits of telemedicine, especially considering the ever-increasing battle against COVID-19.
COVID-19 & TELEMEDICINE
COVID-19 has changed the way individuals interact with one another not just at work and home but most notably in the area of healthcare. Telemedicine gives individuals the opportunity to stay home and receive care which in effect assists to slow the spread of the virus. It helps to better equip hospitals to meet the needs of the increased number of patients present in emergency rooms and intensive care units. Telemedicine presents great strides in “helping to flatten the curve.” Telemedicine also allows physicians to see more patients since it cuts out the travel time for patients as well as the potential for tardiness or rescheduled visits. It also assists in reducing the need for personal protective equipment.
Telehealth also helps eliminate the barriers to healthcare in rural areas where access to healthcare specialist is limited. Furthermore, with the evolution of telemedicine programs, physicians are often able to automatically transcribe medical records during patient exams which increases accuracy in billing and allows doctors to devote more time to patient care than on tedious paperwork.
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