Let’s make expanded telemedicine permanent
Paradoxically, in forcing some patients to stay home, the pandemic is spurring a digital revolution as health care providers rapidly scale up remote-access options for patients.
A trip to the doctor is never just a trip to the doctor. Time off from work can add financial strain, missing school can affect academic performance for children, and the time and cost of commuting limits when and how families can even reach a doctor. The COVID-19 pandemic has made matters worse. To mitigate the harm, nonessential care has been transitioned to telemedicine with providers calling their patients or video-conferencing. The trip to the doctor has gone virtual, joining the long list of new norms in our lives.
Telemedicine helps to keep patients home while maintaining continuity of care with their doctors. Emergency rooms have set up telemedicine triage centers, gathering histories of symptoms to determine who should come in and who can safely stay away from the hospital. Primary care doctors are offering telemedicine for patients who don’t need immediate preventative care interventions like vaccines or screenings. And specialists are remotely monitoring blood glucoses and insulin doses for patients with diabetes, adjusting inhalers for children with asthma, and following up on post-surgical recoveries.
The federal government and states have issued emergency rules for reimbursement parity of telemedicine and in-person visits for a broad array of services covered by
Medicare, Medicaid, and private insurance. Such policies overcome previous obstructions to the widespread adoption of telemedicine. Telemedicine has long held the potential to bridge critical access-to-care gaps in the United States. Now is the time to expand these emergency rules for telemedicine into permanent health care policy after the COVID-19 pandemic.
Through last year, the Centers of Medicare and Medicaid Services had limited reimbursement parity for telemedicine for patients with Medicare to a selective list of conditions including end-stage kidney disease, substance use disorders, and strokes. To previously qualify for telemedicine visits, patients needed to live in designated rural or underserved areas and travel to an approved local health facility where their telemedicine visit would take place. This latter provision enabled facilities to bill for hosting telemedicine services, and patients’ homes were specifically not approved by Medicare. States are responsible for establishing their own telemedicine policies for Medicaid and private plans, and policies have varied widely. For example, according to the Center for Connected Health Policy, while most states have laws regulating telemedicine patients with private plans, just six required reimbursement parity prior to COVID-19.
The landscape of telemedicine has since changed drastically, at least for now. Last month, the CMS broadened the services covered by Medicare by eliminating geographic restrictions on telemedicine for Medicare and authorizing reimbursement parity for routine office visits, mental health and preventative screenings. As the pandemic has continued, CMS has expanded its emergency rules to include coverage for home assessments of emergencies and monitoring of patients with COVID-19. Following suit, nearly every state has amended their telemedicine regulations. Most states are approving homes as eligible “originating” sites for telemedicine and they have required reimbursement parity by all state Medicaid plans, with some requiring all private insurers or “in-network” providers to do the same.
These changes should be made permanent.
Unexpectedly, COVID-19 has launched an experiment-by-necessity to test the feasibility of large-scale telemedicine in the United States. The results may fundamentally change how health care is practiced in the future. Patients, providers, and policymakers alike should pay attention.
Telemedicine is not a panacea for all access-to-care gaps. Significant percentages of Americans lack broadband access or smartphones. However, the telemedicine policies and infrastructure implemented during COVID-19 can become patient-first innovations. After the pandemic, the federal government can sign its emergency rules for telemedicine reimbursement into law and should support states in doing the same.
If, after the pandemic, these emergency changes are made permanent, telemedicine can help limit the burdens families experience from health care in their daily lives. Paradoxically, in enabling some patients to stay home, more will be able to access care.