Telemedicine: Charting a New Course

Dawn Holcombe, MBA, FACMPE, ACHE
Editor-in-Chief
President, DGH Consulting, South Windsor, CT

Every cloud has a silver lining. The chaos and uncertainty that the novel coronavirus disease (COVID-19) brought to the US healthcare system this spring has had a cataclysmic effect on the mainstream adoption of telemedicine and virtual health visits that will probably never be undone. These advances in technology will benefit medical practices and their patients in much needed ways, such as lowering costs, improving patient access, increasing the timeliness of care, and reducing the risk for unnecessary exposure to various elements for patients and staff alike.

Telemedicine, which was first introduced approximately 50 years ago, covers a wide array of technologies that allow better communication between providers and their patients. We have a plethora of tools at our disposal that, until the COVID-19 outbreak, had been underused and poorly reimbursed. A July 2018 Medical Group Management Association Stat Poll reported that 90% of responding healthcare leaders said that their practices offered a patient portal. However, less than half (43%) of those leaders accepted patient-generated health data, 37% did not accept patient-generated health data, and 20% were unsure.1

Patient portals are the first line of communication with patients once they leave the walls of the practice, offering messaging, test results, updates, education, and alerts. However, these portals can be cumbersome, are not connected to other providers caring for the same patient, and tend to be accessed infrequently by patients.

The Office of the National Coordinator for Health Information Technology published a brief in April 2018 reporting that only 28% of individuals nationwide viewed their available online electronic medical records at least once in the previous year.2 I am signed up for a patient portal with my primary care physician, and have accessed it only once in the past few years. For me, it does not deliver enough value or interaction to make it worth the trouble of signing in.

Telemedicine in Oncology

Telemedicine in oncology can be an important asset for physicians and patients. It can expedite and simplify requests for prescription refills, allow physicians to remotely guide other physicians and paramedics through triage and rapid treatment, and allow video and photographic transmissions to provide guidance and advice on various conditions. Patients with cancer can use telehealth for consultations and to receive answers to questions or concerns related to diagnosis, treatment plans, or unique situations that may arise. Texting and messaging applications can provide coaching and answer questions about treatment-related side effects or supportive care. Smartphone apps and wearable technology can be used to monitor pain, vital signs, and even the potential need for intravenous hydration. Although these technologies are not a substitute for direct care, and should be used judiciously, they can enhance care and increase patient satisfaction.3

Even before the COVID-19 outbreak, oncology leaders were exploring the use of telemedicine. In an April 2019 interview, Judd E. Hollander, MD, Associate Dean, Strategic Health Initiatives, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, discussed the ways in which his institution was using telemedicine in oncology. He explained that the technology was used to facilitate scheduled virtual visits between patients and providers, perform melanoma screenings, and conduct remote visits with the emergency department. He also discussed how the college was using direct-to-patient apps for communication and remote monitoring of patients.

Many other institutions are seeking ways to integrate this technology into patient care. For example, Memorial Sloan Kettering Cancer Center, New York City, now provides psychiatry services and counseling to patients with cancer via telehealth services, and the Seattle Cancer Care Alliance, WA, is piloting a telemedicine project in palliative care that involves real-time virtual follow-up visits in a patient’s home.

In 2019, differing state-to-state requirements governing physician licensing requirements and Medicaid and private insurance coverage, as well as Medicare rules limiting when and where telehealth could be billed, created significant barriers to the expansion of telehealth services. Some states still had no parity laws requiring insurers to cover telemedicine visits, which severely restricts innovation in care delivery on the part of providers.

The Future of Telemedicine

On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it would lift federal restrictions on payment for telehealth provided to Medicare patients. The expansion will allow all Medicare beneficiaries (not just those living in rural areas as had been the previous restriction) to receive care in their homes through audio and visual communication, and for providers to bill for those services at the same rate as they would for in-patient visits.4 Existing restrictions for state licensure requirements were not eased. However, individual states have also already begun considering new regulations for telehealth.

The rapid deployment of existing telehealth programs skyrocketed in the days following this announcement. The JeffConnect telehealth service at Thomas Jefferson University had a 10-fold surge in the demand for screening, and the number of physicians staffing the service quickly jumped from 1 to 10, and more are planned. Online training modules are preparing physicians for this new mode of care delivery at other institutions, such as the University of Arkansas for Medical Sciences, Little Rock, which has significantly ramped up its training.

Now that the genie of virtual healthcare is out of the bottle, I find it hard to believe that we will revert to the days when coverage and legislative restrictions limited such logical services. At a time when we are reviewing all healthcare delivery with an eye toward enhanced value performance, risk management, and cost reduction, these innovations cannot be ignored. We need to learn how to do more with less and expand the resources of our medical community in ways that can leverage technology for site-of-care delivery and maximize the utilization of dwindling resources. Virtual screening and diagnostics not only better serve the unprecedented demand for medical care, but also protect healthcare providers and potentially otherwise healthy patients— as well as the rest of the patient community— from infectious diseases.5

I foresee a time when, instead of counting hospital beds and office visits, we will be tracking patient encounters at numerous locations, including patients’ homes and various medical facilities. Physicians and practice administrators should, when they can take a breath, review all our perceptions about traditional care delivery and what we have been able to accomplish this spring; this will lead to the development of further innovations. Now that the floodgates have opened, we have a golden opportunity to help chart a new course in healthcare delivery.

References

  1. Medical Group Management Association. MGMA stat: most practices offer a patient portal. July 26, 2018. www.mgma.com/news-insights/quality-patient-experience/mgma-stat-most-practices-offer-a-patient-portal. Accessed March 25, 2020.
  2. Patel V, Johnson C. Individuals’ use of online medical records and technology for health needs. April 2018. www.healthit.gov/sites/default/files/page/2018-03/HINTS-2017-Consumer-Data-Brief-3.21. 18.pdf. Accessed March 26, 2020.
  3. Schapira L. Telemedicine in cancer care: rewards and risks. March 26, 2019. www.cancer.net/blog/2019-03/telemedicine-cancer-care-rewards-and-risks. Accessed March 25, 2020.
  4. Centers for Medicare & Medicaid Services. Medicare telemedicine health care provider fact sheet. March 17, 2020. www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed March 26, 2020.
  5. Redford G. Delivering more care remotely will be critical as COVID-19 races through communities. March 23, 2020. www.aamc.org/news-insights/delivering-more-care-remotely-will-be-critical-covid-19-races-through-communities. Accessed March 26, 2020.

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