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Telemedicine Faces Uncertain Future

Post-Pandemic Regulations Threaten Access

Telemedicine visits are on the decline

By Bob Sterner –

As Coronavirus filled hospitals and lockdowns closed businesses and schools, interest soared in getting medical attention remotely at home. The push to what is commonly known as telemedicine wasn’t surprising given health conditions, operating restrictions and regulatory adjustments that made remote visits more attractive for physicians and patients alike.

When the pandemic hit, remote visits via telephone or the internet surged to 20,000 per month alone at New York City’s Mount Sinai Hospital compared to just a few hundred per month, according to The Doctors Company. On a national level, FAIRHealth monitors Medicare claims and private claims. Nationwide reports that nearly 8 percent of patients opted for remote services starting in 2020 instead of face-to-face visits that were the norm.

The future of remote visits may be facing some headwinds due to potential regulatory restrictions, differences between states, lessening financial incentives and desire on the part of some patients for direct access to medical personnel. Remote visits are already down from the pandemic highs.

There are two categories of remote medical services by the World Health Organization. These include telemedicine, services administered only by a physician, while Telehealth represents a broader range of services such as patient education, information and self-care. There was better access to both in 2020 through congressional acts during the early stages of the pandemic.

Both have shown increasing benefits and are particularly well-received by patients with mobility issues or who live in areas with limited medical facilities. The Doctors Company sees Telehealth as an adjunct for in-office visits, especially for specialties like cardiology, dermatology, hospital care follow-up, pediatrics and family care.

Before the pandemic, state and federal regulations limited Telehealth and Telemedicine, which the Coronavirus Aid, Relief and Economic Security act helped ease. The CARES act allows the Centers for Medicare and Medicaid Services (CMS) to grant physicians the ability to treat Medicare patients in other states remotely.

The CMS also dropped limiting remote sessions to devices supported by the Health Insurance Portability and Accountability act so they could happen over applications such as Facetime, Skype, Zoom or even just over the telephone. It also allowed providers to be paid for services as if they were in the medical office. Although the changes affected only Medicare cases, they encouraged changes for state-administered Medicaid and privately operated programs, allowing their member physicians and institutions to maintain their medical practices.

The relaxed standards extend through 2023, except for Medicare mental health and substance abuse issues, which have no geographic restrictions, according to Peterson Center on Health Care. With the pandemic receding, states are now eager to resume control of regulating medical services within their borders. These reasserted regulations impact access to remote medical hinges on how states and medical providers address physician licensing, payments and confidentiality issues, and public demand.

A big hurdle is physician licensing. States require licenses and insurance to ensure medical practitioners meet their standards. After 2023, physicians would need one for every state they offered remote services. The Association of American Medical Colleges sees one solution to this roadblock: being the Interstate Medical Licensure Compact. It would allow physicians to practice within the 30 states that have signed up for the IMLC. However, several large states—including California, New York and Florida—have yet to sign on to the compact, which could potentially undermine its attractiveness, signed on to participate.

Another pending issue is that once the designated public health emergency ends in 2023, Medicare may revert to remote visits only offered in rural areas. Congress would need to permanently extend the program’s in-home cover options to have coverage. Since urban areas have the best internet infrastructure, limiting remote visits to rural areas may curtail telehealth use.

Early in the pandemic, federal reimbursement policies allowed payments for remote visits to be at parity with in-person ones, giving physicians incentive to participate since telehealth visits take less time. Discontinuing parity could also undermine the cost-effectiveness of Telehealth.

The National Center for Biometric Technology sees digital security as a multi-level issue, not just because health, payment and contact information could be a goldmine for hackers. Secure connections are essential between the medical provider and the patient to limit misdiagnosis that could lead to malpractice suits or abuse to secure illegal drugs. With the Supreme Court’s recent ruling regarding abortion rights, drugs that induce abortions may be illegal in some states, exposing the prescribing doctor and the patient to possible criminal liability.

Telemedicine has enormous growth potential, especially with the advent of monitoring devices such as Fitbit activity trackers, Kardia EKG monitors and blood pressure devices that allow for more diagnostic steps at home. The physician can see the data stored electronically, if needed. Remote visits are often more practical and efficient for all parties. Plus, people have become used to them during the pandemic.

Growth may be limited unless state and federal governments work with the medical industry to bridge the gaps that limited services before the Coronavirus pandemic.

 

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