Telehealth: Healing from a distance while increasing patient ‘touch’

These are interesting times for health care professionals. While technology has been evolving rapidly over the last decade to allow for telemedicine, it hasn’t been until the last few weeks that our health system has had to rapidly adapt to seeing and managing patients virtually. Health care providers can now be more accessible to advise patients and manage their health via electronic communication.

Telemedicine is the remote delivery of health care services. A patient’s medical information is exchanged from one site to another through electronic communication. Equipment must have audio and video capabilities to accommodate two-way, real-time communication. The services are the same, the patient is just not in the same room with their health care provider.

Telehealth is a broader term that describes a collection of methods to improve patient care and deliver health education. It includes telemedicine, health administrative functions, and health education for patients, professionals and the public.

Patients can seek telemedicine care for any reason or diagnosis. It does not have to be related to our current pandemic with COVID-19. However, telemedicine received a huge boost when the federal government, in response to the COVID-19, changed its policy last month to allow health care professionals to provide telemedicine services to Medicare patients and be reimbursed.

Prior to this policy change, Medicare patients had to have a prior established relationship with a health care professional before Medicare would reimburse for telemedicine services. Having these restrictions lifted has benefitted the implementation of telemedicine. Medicare also waived all penalties for HIPAA violations against health care providers who serve patients in good faith through everyday communications such as FaceTime or Skype. These changes remain in effect during the COVID-19 emergency.

There will always be an important role for face-to-face visits (such as the annual check-up) with your health care provider, when it is again safe to schedule them.

Health care providers covered by the Medicare change include physicians, nurse practitioners, physician assistants and certified nurse midwives. Within their scope of practice, certified nurse anesthetists, licensed clinical social workers, clinical psychologists, and registered dietitians or nutrition professionals may also provide services. Providers who are making telemedicine services available should have already informed and received permission from their patients.

The advantages of telemedicine include:
• Vulnerable patients with mild symptoms can stay at home to limit community spread of disease and exposure to other patients and staff;
• Patient convenience, privacy and confidentiality can be maintained during real-time communication;
• Wait times almost disappear; support staff contacts the patient and gathers patient information to get them ready for a visit with their provider;
• Access to a wider range of health care services, especially in rural areas;
• Ability to share patient information with specialists and increase collaboration among patient’s health care team;
• Lower costs for patients, providers and potentially for payers;
• Transportation arrangements not required;
• Avoid missing work and having to arrange for child or elder care;
• Prevent unneeded and expensive emergency room visits;
• More communication with patients leads to better patient outcomes; and
• Providers can see more patients without expanding staffing or office space.

Patients of all ages are increasingly comfortable with virtual health care due to urgency, convenience or inability to take off work. However, not everyone will like or use telemedicine. For payers and providers, keeping up with reimbursement policies and privacy protections can be challenging and the laws are different in each state. Rapid changes in technology and uncertainty about reimbursements make some providers ignore it altogether.

Some older adults, and their providers, may be more comfortable with face-to-face appointments. There can be a potential for error, because technology cannot capture what human skills and experience can reveal.

Patients are still responsible for out-of-pocket costs for co-pays and deductibles. However, Medicare has given health care providers the discretion to reduce or waive cost-sharing for telemedicine visits paid by Medicare.

For employers, telemedicine is a great way for your employees to have their health care needs addressed with less time away from the office. Telemedicine reduces the likelihood that employees will delay or ignore their health needs. It increases the efficiency and reduces the cost of health care for your employees as well as improves the health of your workforce.

Some of the most effective uses of telemedicine are:
• Chronic disease management; 75% of U.S. health care spending is to treat chronic heart disease, cancer and diabetes;
• Medication management; improved medication compliance reduces disease relapse and hospitalizations;
• Reduced use of emergency room (ER); a virtual visit lets the provider determine if patient needs ER or a less expensive option;
• Second opinions;
• Post-surgical and post-partum care;
• Substance abuse;
• Home dialysis;
• More efficient use of health care personnel during disasters, when need increases; quarantined doctors can practice via telemedicine;
• Behavioral health; and
• Monitor patients at home via mobile medical equipment including stethoscopes, EKGs, pulse measures, ultrasound, blood pressure cuffs, otoscopes and dermatoscopes.

There are still many barriers to internet access – poor connection in rural areas, having the necessary equipment at home and knowing how to use it. But telemedicine and telehealth will become a part of the new normal for us all. They are quickly becoming an important component of health care delivery. We must continue to work together to make telemedicine a quality experience for everyone.

Editor’s note: Dr. Chad Rodgers is vice president and chief medical director with Arkansas Foundation for Medical Care and is a practicing pediatrician in private practice. The opinions expressed are those of the author.