8- TELEMEDECINE & TELEHEALTH by PHARMAGEEK

As providers are scrambling to transition in-person appointments online, they’re seeing the advantages and unexpected benefits of telemedicine. Here are five ways telemedicine is aiding in the fight against COVID-19.

1. Giving patients a virtual option for regular appointments reduces their risk of unnecessary exposure.

Normal health issues don’t stop for a pandemic. Moving appointments to a virtual setting can help doctors provide follow-up care for at-risk patients remotely, ensuring that patients aren’t accidentally exposed to COVID-19.

It also works the other way: patients who are worried they may be infected but don't need to go to the hospital can check in with their doctor through live video, without worrying about exposing others. It also eliminates the possibility of picking up COVID-19 at the hospital if it turns out they weren’t already infected.

2. Through remote appointments, quarantined healthcare providers can still care for patients.

If a healthcare provider is exposed to COVID-19 and must self-quarantine, or is at a higher risk of serious complications from COVID-19, telemedicine can provide them with a way to continue working.

Clinicians can conduct virtual appointments from home and still provide patients with a high level of care, while relieving some of the strain on the care teams on-location at the hospital.

3. Even in the hospital, clinicians can see patients remotely, conserving valuable Personal Protective Equipment (PPE). 

Using telemedicine within the hospital itself can also prevent clinicians from being exposed to COVID-19. By setting doctors up with video-enabled devices, they can conduct examinations without ever entering a potential COVID-19 patient’s room, saving PPE for nurses and other caregivers who come in contact with patients.

4. Telemedicine can help doctors see patients who would otherwise avoid making appointments.

While there are still many obstacles with how much insurance companies will agree to cover for remote appointments, telemedicine may reduce the cost of some appointments.

This could help attract patients who otherwise could not afford a doctor’s visit. Being able to expand into new demographics and provide them with quality care can help doctors better mitigate the spread of COVID-19.

5. Telemedicine appointments allow for new flexibility, discoveries, and creativity in patient care.

While the COVID-19 pandemic has changed our lives in many negative ways, there is a silver lining: it has illuminated the human capacity for creativity, resourcefulness, and discovery in the midst of tough circumstances.

Clinicians who previously assumed that their services could not be adapted to a telemedicine format are discovering that virtual appointments can give them a valuable insight into patients’ home lives, helping them come up with therapy ideas specifically suited to each patient’s home environment.

Sahana Baker-Malone, a pediatric occupational therapist, told The Mercury News: “We’re getting to participate in their normal life as opposed to bringing them into our clinic, where we see kind of constructed sessions.”

The long-awaited promise of telemedicine may finally be realized as a response to Covid-19.

For decades, advocates hailed telemedicine as the way forward to improve access and reduce cost, while maintaining high-quality care.

There have been steady gains in investment and growth across the country, and an increasing number of studies suggest that for certain services, namely chronic care management and mental health services, telemedicine may be superior to in-person care. Specifically, studies showed better health outcomes through improved medication adherence, integration of medical tests, and reduced hospital readmissions. However, even with these positive steps, it would be a stretch to claim that telemedicine had transformed the US healthcare system and, in large part, that is because of legal barriers that were in place prior to Covid-19.

In the Fall of 2019, my colleague at the University of Arizona James E. Rogers College of Law, Christopher Robertson, and I identified three major legal barriers in federal and state laws that were inhibiting telemedicine utilization.

We reviewed (1) establishment of a healthcare relationship, (2) state licensure laws, and (3) reimbursement. We focused on these areas because of the legal ambiguities or inconsistencies, which varied across the states. Arguably, these variations could hinder telemedicine operators’ ability to leverage resources across state lines for efficient scalability without necessarily improving quality of care. 

Aging Population

We proposed that the

growing aging population would be the driver to achieve greater utilization of telemedicine services largely because of changes with reimbursement under Medicare Advantage (MA).

The Center for Medicare and Medicaid Services (CMS) issued a rule that became effective at the start of 2020, which relaxed geographic and originating site requirements to allow reimbursement for telemedicine services received directly in the home, irrespective of whether the MA beneficiary lives in a rural or urban area.

In addition, many state Medicaid programs, including Arizona’s AHCCCS, reported plans to expand reimbursement, especially around long-term care services and for home healthcare.

We found that older adults, aged 65 or over, represented a large market that was unfamiliar with telemedicine. A 2018 study found 16-times greater telemedicine utilization among adults aged 24-44 and a 2019 survey reported that while half of older adults would be interested in a telemedicine visit, only four percent had one in the last year.

These findings highlight major growth opportunities, particularly given telemedicine’s demonstrated ability to effectively manage chronic conditions, where 80 percent of older adults have at least one chronic condition, and 77 percent have at least two.

We had no idea that COVID-19 would be the watershed event that would bring the long-anticipated discussion of how to expand telemedicine and care for the aging population to the forefront of this pandemic.

Legal Barriers

Our recommendations for a more unified approach to telemedicine regulation incorporates core bioethics principles of doctor-patient relationship, competence, patient autonomy, as well as population-wide questions of resource allocation and access. In the time of Covid-19, many lawmakers have embraced some of these principles and allow greater flexibility.

Specifically, in how a healthcare relationship may be established outside of a “hands on” visit (see e.g., Maryland’s Governor amended an order to allow formation of a provider-patient relationship to include audio-only calls).

In addition, many states relaxed licensure laws and reimbursement under CMS has expanded to include all Medicare beneficiaries (approx. 56 million people). Section 3701 of the CARES Act went even further to encourage telemedicine use by removing cost-sharing exposure under Medicare for any telemedicine services, irrespective if related to COVID-19.

Conclusion

The threat that Covid-19 poses to the elderly population and a resource-strained healthcare system greatly outweighs some of the former legal barriers to telemedicine expansion. The new economies of scale that have now undoubtedly been achieved have the opportunity to bring the telemedicine promise of - greater access, improved health outcomes, and lower costs – and would benefit from using core bioethics principles as a guide in this new era of virtual care.