HISTORY:
The once familiar doctor housecall had all but disappeared long before the CoVid-19 virus wrought havoc across the world. All but gone were the visits of the physician with the Gladstone bag, complete with every instrument a general practitioner would need.
Thankfully, medicine has moved beyond the bloodletting of the three physicians who essentially killed former President Washington on December 14, 1799, after having visited him at home, and blood let at least half of his blood.
Physicians, though reluctant to engage new expensive technologies, had been exploring the option of homecare and housecalls again. This preparation came in handy for patient and physician alike. The term, telemedicine, once a term isolated to tech loving physicians, is now commonplace in light of social distancing required by the pandemic, that many are now calling a syndemic.
PATIENTS:
What can patients expect in telemedicine during the syndemic?
Patients can expect to be able to discuss medical issues in the comfort of their homes. Sounds great, right?
But how will blood pressure be taken, and other vitals?
There are new apps available to take these vitals, but in urgent matters patients must still be seen in person.
Will patients be seen more promptly?
Yes, wait times will be shorted, the number of in office visits reduced and patient tracking came be more easily facilitated.
What types of healthcare can patients receive through telemedicine?
- Screening for COVID-19, testing recommendations, and guidance on isolation or quarantine
- General health care (i.e. wellness visits, blood pressure control, advice about certain non-emergency illnesses, like common rashes)
- Prescriptions for medication
- Nutrition counseling
- Mental health counseling
What’s a downside?
Before the syndemic, insurance companies and government didn’t always cover such treatment, though the recent CoVid-19 emergency has forced coverage in a greater degree.
Chances are, most physicians have already implemented or considered implementing many telemedicine interactions.
PHYSICIANS:
The profession has recognized the benefits of telemedicine, but practitioners have been slow until the advent of social distancing to embrace many of the newer technologies.
Reasons for physician reluctance before the syndemic include, according one recent study:
- 36% are concerned about medical errors
- 35% say their workplace doesn’t offer these technologies
- 33% have qualms about data security and privacy
- 23% indicate patients are not interested or lack technology to connect
- 22% feel it does not fit into their workflow
- 18% cite increased practice costs
- 8% aren’t interested
- 5% don’t see a need
- 11% cited other reasons.
The study discovered the benefits to patients and physicians included:
“Without the telemedicine service,
27.9% of parents would have visited the ED; a projected savings to the Florida healthcare system of approximately $113.9 million based on comparative data from the Florida ER Utilization Report.
Another 36.6% of parents would have gone to an urgent care center; researchers did not calculate the potential financial impact of this measure.
Only 6% of the parents stated they would have done nothing if the telemedicine service was not available.”
Although the need and recognition for telemedicine coupled with AI was established well before our current predicament, current circumstances have cemented the benefits and demand.
Current telemedicine technology and applications can provide a bevy of information quickly, in an easily recorded fashion, some often including their own integrated ECR, as well as diagnostic hints and tools. Physicians should avoid leaning too heavily upon them, but the help aids should be useful.
Naturally as with any innovation come hurdles and drawbacks; the two most important are licensing and compensation, which healthcare lawyers can explain further. Only half of the states have entered into an interstate licensing compact, called the Interstate Medical Licensure Compact, that will enable physicians to serve patients remotely via telemedicine more easily via uniform regulation and licensure. Attached below is a link to the 25 states adopting the Compact. Congress has also proposed as of December 10, 2020, the Temporary Reciprocity to Ensure Access to Treatment Act, “Treat Act” to address some of these regulatory concerns.
The final primary issue is reimbursement or compensation. The resolutions are still evolving, but effective March 1, 2020, Congress made significant changes to Medicare reimbursement for telemedicine, including:
Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just services related to COVID-19.
Office-based physicians should use their usual place-of-service (POS) code to be paid at the non-facility rate for telehealth services and add modifier 95 to telehealth claim lines. Telehealth services billed using POS code 02 (telehealth) will be paid at the facility rate.
Physicians can reduce or waive Medicare patient cost-sharing for telehealth visits, virtual check-ins, e-visits, and remote monitoring services.
Code selection and documentation guidelines for office visits performed via telehealth will be based on physician time spent on the date of visit or medical decision-making (MDM). CMS will utilize the 2020 physician time and definitions of MDM.
The CARES Act CMS release also provided advice and relaxation of technology requirements, as well as a toolkit for Medicaid and CHIP recipients.
As is often said, “the future is now” and CoVid-19 has brought medicine back into our homes through easily adapted and new technologies. As the attorneys can attest, these changes are likely to accelerate more.
