Delivering Health Care Through Telemedicine
- Telemedicine is the use of technology and electronic communication to provide health care to patients, often in real time. It can address barriers to health care access such as physician shortages, especially in rural areas.
- Policy issues, such as those related to licensing and paying providers, can limit the use of these technologies.
- The coronavirus supplemental funding law included a provision to allow Medicare to cover more telemedicine services during the public health emergency and help reduce the risk of patients being exposed to the virus.
Telemedicine uses technology and electronic communication to provide long-distance health care to patients, especially when treatment in person may not be an option due to timing or geographical barriers. The technology has the potential to change how medicine is delivered, expanding access and addressing provider shortages. Rural areas especially can benefit from the advances. The technology can also be useful during public health emergencies.
Connecting Patients with Care
The concept of telemedicine covers a wide range of technologies that have allowed people to get health care remotely. In some sense, it is as old as the first person to call a family doctor on the phone to ask about a sick child. As the tools have advanced, the kinds of care that can be offered have increased, with the potential to change the way health care can be delivered.
According to the Health Resources and Services Administration, there are more than 1,300 geographical areas across the country that have a shortage of primary care providers; approximately 900 of these are rural areas. People in these places may have trouble traveling to the nearest doctor and may have longer wait times for an appointment or more difficulty coordinating their care with other practitioners. The Association of American Medical Colleges estimates that the demand for physicians will continue to outpace supply. It expects that by 2032 there will be a shortage of up to 122,000 physicians in the United States.
Even in places with plenty of doctors and other medical services, telemedicine may have benefits. Patients could get some care more conveniently from their homes or outside of traditional office hours. This may especially help people who lack access to transportation, suffer from chronic conditions, or are too sick to travel. These types of services are being used in many settings, including in schools, nursing homes, and prisons. For example, a patient can wear a monitoring device that sends health data to his doctor through a “store and forward” app on his phone. The doctor can react to this data by adjusting prescriptions or making other treatment recommendations.
Kaiser Permanente has a “virtual cardiac rehab program” in which cardiovascular patients wear a smart watch to track their condition. The device gives patients reminders to exercise more and allows them to meet virtually with a care manager to talk about their progress. The company has found that less than 2% of patients in the program were readmitted to the hospital for cardiac conditions, compared to readmission rates of 10% to 15% in other programs.
In other uses, a patient could enter symptoms into her doctor’s web portal and get recommendations. Or a dermatologist could screen for skin cancer by reviewing patient data and securely delivered photos, allowing patients to get examination results faster.
Limits on Utilization
Many telemedicine options are limited to facilities with specialized equipment. For example, a patient may be in an intensive care unit while being monitored by a specialist at another location. Or a patient in an ambulance might be connected to physicians waiting at the hospital, allowing treatment to begin during transit.
Some of the limits on wider adoption of telemedicine are practical – it would be impossible to install some of the necessary equipment in people’s homes. Others are technical – remote surgery conducted via robot in distant locations has great potential, but the technology is not yet ready for widespread use.
Still other limits on the use of telemedicine are regulatory. Medicare typically reimburses for telemedicine services only if a patient is located in a federally designated rural or health professional shortage area. It also covers a limited number of services and specifies a patient must be at an “originating site” such as a critical access hospital, skilled nursing facility, or mobile stroke unit.
States regulate the practice of medicine and can affect the adoption of telemedicine through their Medicaid programs and laws pertaining to reimbursement by state-regulated private insurance plans. These laws affect the use of the technology, as doctors may not invest in new equipment or use telemedicine if they cannot be appropriately reimbursed for the services provided. Some states require private plans to cover care delivered via telemedicine at the same rate as care provided in person, which may leave insurance companies with little incentive to increase telemedicine use.
There also are variations in state licensure requirements that limit use of telemedicine services. Generally, physicians must be licensed to practice medicine in the state where the patient is physically located. Each state determines licensing requirements for people practicing medicine there, which may affect a patient’s ability to get care from a provider in another state. Some states participate in interstate compacts that can allow for care across borders in certain circumstances.
The Centers for Medicare and Medicaid Services is working to increase access to telemedicine. Last year, the agency added several services to its list of the kinds of care covered by Medicare. Congress has also acted to expand the use of telehealth in Medicare by eliminating barriers for specific conditions:
It eliminated an originating site geographic restriction and allowed mobile treatment units to become eligible for reimbursement for diagnosis and treatment of beneficiaries with acute stroke symptoms.
Medicare patients with end-stage renal disease receiving home dialysis can get required periodic check-in visits with their physician at home.
People enrolled in Medicare who are seeking care for substance use disorders and some mental health disorders are able to receive telehealth services from home.
Most recently, the coronavirus supplemental appropriations package passed by Congress on March 5 included a provision to expand telehealth. This gave the secretary of health and human services the authority to waive certain limitations and allow more telehealth services to be paid under Medicare Part B during the coronavirus public health emergency. Typically, Medicare reimburses for telemedicine services only if the beneficiary is in the physician’s office or other designated originating site that is in a rural area. Now, during the coronavirus public health emergency, it will cover telemedicine services when the patient is at home and in a nonrural area. The new provision may help reduce the risk of Medicare patients being exposed to the coronavirus as they will be able to avoid hospitals and physicians’ offices.
While these telehealth expansions are for people with original Medicare, Congress also expanded the ability of Medicare Advantage plans to use telehealth to better tailor benefits to the needs of their customers. This builds on flexibility already inherent in Medicare Advantage by enabling plans to broadly include telehealth in the basic package of services or as part of more expansive supplemental benefits.
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