Preserving Telehealth Access in the Face of Uncertainty
Innovations in modern medicine are remarkable, from improving robotic and laser surgeries to developing new treatments for diseases. One area that has seen remarkable development yet remained mostly overlooked in the lists of fascinating developments is telehealth.
Telehealth encompasses various technologies from live-video doctor visits to audio-only and phone consultations, store-and-forward asynchronous consultations (like an email consultation), and remote monitoring of patient health data. Different modes are suitable for different situations. Remote monitoring might work for the day-to-day management of a patient with diabetes or high blood pressure, but asynchronous store-and-forward could better enhance the ability of specialists to consult with rural patients.
This burgeoning revolutionary advance in medicine via telehealth is exponentially increasing.
Why has telehealth become such an important aspect of delivery of optimal medical care to the American public? For starters, multiple treatments for certain emergency medical conditions are time dependent and lose efficacy without prompt treatment. Strokes, pulseless limbs, and heart attacks will result in irreversible cellular injury and death the longer the artery is blocked. Overwhelmingly, only large academic centers have on-site specialists available to provide definitive interventions for these patients. Telehealth has successfully bridged the disparity by connecting patients in rural and community hospitals with the appropriate specialist in the large centers.
With the increasing sophistication of tele-robotics and especially 5G technology, the idea of remote surgery that began with NASA in the 1970s is now becoming mainstream.
Of course, the vast majority of telehealth will involve the primary care setting with the potential to provide better accountability and use of the physician-patient covenant of trust. Instances where virtual meetings can enhance this relationship is in managing chronic illness, wellness, and minor urgent care.
Since the COVID-19 pandemic began, many temporary measures were passed to ensure people did not lose vital healthcare coverage. Telehealth flexibility was one such measure that accompanied the president’s public health emergency declaration. The temporary federal telehealth rules expanded access to millions of Medicare participants in rural areas, with mobility difficulties, or concerned about the risk of catching COVID-19 or other diseases while in a doctor's office.
Unfortunately, the temporary nature of the rules causes great uncertainty.
As the most recent deadline of July 15th approached, many became understandably nervous. Fortunately, the Biden administration extended the emergency declaration until October.
Last year, the Centers for Medicare and Medicaid Services (CMS) ended the ambiguity for those receiving mental health treatment. It announced that it was making a permanent change to allow Medicare telehealth coverage for behavioral health care. As the American Psychiatric Association (APA) stated in a press release, this permanent change was “an enormous victory for patients and psychiatrists.”
This rule change was a monumental win, but the fact remains that millions of other patients receiving telehealth for a wide variety of other specialties remain vulnerable. The Kaiser Family Foundation (KFF) reports that once the emergency declaration expires, "most Medicare beneficiaries will lose access to coverage of nearly all telehealth services…." Considering "over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic," that would be a massive blow.
Fortunately, states seem to be taking things into their own hands, according to the National Council of State Legislatures, 37 states have made their previously temporary telehealth measures permanent. Every state now covers live video telehealth visits; however, other telehealth technologies such as "store-and-forward" and remote patient monitoring have less coverage—only 22 and 27 states, respectively.
In addition, the U.S. House of Representatives passed legislation in July that would provide Medicare recipients access to telehealth services through the end of 2024. The legislation is now in the Senate where it awaits consideration.
Everything with telemedicine is perfect, and there are some unforeseen barriers to surmount. Lack of in-person interaction, the potential complications that can arise from tele-surgery, and substituting less trained medical personnel to supervise the bedside portion of the technique should be appropriately viewed as a safety hazard and unethical.
But obstacles can be overcome.
These modes of care have been developed, enhanced, and successfully deployed by practitioners across the country. Experience has proven that telehealth is up to the challenge and can deliver quality care. We must act before expirations cause enormous upheaval and discontinuity in coverage.
Gregory Wheeler, DO. is a practicing emergency medicine physician, Dr. Wheeler’s focus is keeping patient care as the bedrock of medicine.
