When COVID-19 began to spread across the United States in early 2020, the national telehealth infrastructure went on trial.
The most important thing for hospitals was to minimize personal care – not only to limit the spread of the virus, but also to ensure that hospitals were not flooded, as in Italy. This is a key reason why in March, Medicare and most private insurers tried to increase access to telehealth by easing restrictions, waiving fees, and reimbursing practitioners for virtual visits at the same rate as personal visits.
Shortly after the establishment of these temporary measures, visits to telehealth increased sharply. A U.S. Department of Health and Human Services report found, for example, that about 43 percent of primary health care visits were made via telehealth in April, compared to only 0.1 percent in February.
How did that transition go? Despite having only a few weeks to prepare, most U.S. healthcare organizations have managed to massively increase their virtual number of cases with astonishing flawlessness. Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, was one of thousands of health professionals who witnessed the transition.
“We went from the proverbial‘ zero to 60 ’over the course of a few weeks and provided good care with a very high degree of patient satisfaction,” Doerfler said.
Prior to the pandemic, Northwell Health – New York’s largest hospital system – made about 150 telehealth visits a month between 20 to 40 doctors. But in May alone, Northwell made about 65,000 visits with approximately 8,000 health workers across the health care system.
Doerfler cited the example of a single mother whose young child had chronic illnesses, including respiratory problems, making personal visits particularly dangerous during a pandemic. The pediatrician was able to assess the child, talk to the mother through a telehealth translation service, and provide the family with the necessary steps to keep the child healthy. The mother was happy to avoid taking her child by public transport to visit the hospital in person and still receive the necessary care.
Three hours of driving 200 kilometers is no different from three hours of driving two trains, two buses and a taxi.
Clinicians in Northwell have used telehealth to adapt to the pandemic in many ways, from sending phlebotomists to nursing homes after virtual visits, to connecting new mothers with breastfeeding professionals through secure, encrypted telehealth channels.
“There are various examples in health care where this technology and the willingness of patients and clinicians to accept it have made it possible to take care of the types of problems that are usually done face to face,” Doerfler said.
Telehealth programs that existed before the pandemic also helped protect both patients and hospital staff by minimizing personal visits. For example, Northwell’s telepsychiatry department connects people in crisis, who can usually go to the emergency room, with a behavioral health specialist in approximately 45 minutes, at any time of the day or week. This is a significant improvement because emergency services usually do not include psychiatrists or other specialists who can help someone who is experiencing a health hazard.
The success of telehealth during the pandemic begs the question: Why hasn’t American healthcare already embraced virtual care?
What are the obstacles facing telehealth?
One of the biggest obstacles to the widespread adoption of telehealth was the lack of national legislation providing financial incentives for health centers to adopt it.
State laws differ in the way doctors are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity – at the same rate as personal visits. But in states without parity laws, health organizations have little incentive to invest in telehealth infrastructure and training.
Access is also a major obstacle. Medicare and Medicaid Service Centers (CMS) generally reimburse physicians for telehealth visits only when patients live in “certain rural areas with insufficient services.”
But not all areas are insufficiently protected in small, remote places. Finally, a single parent living in Brooklyn, New York could have trouble accessing quality health care.
“Three hours of driving 200 miles is no different from three hours of driving two trains, two buses and a taxi,” Doerfler said. “So access will almost certainly be improved by greater availability of telehealth in that direct patient, in their home or office.”
Lack of Internet access is also a problem. A magazine published in August by the JAMA network found that 41 percent of Medicare users do not have a computer with high-speed Internet access at home, and roughly the same number do not have a smartphone with an unlimited data package.
What is the future of telehealth?
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Lawmakers in both parties and health workers have indicated a desire to permanently implement some of the regulatory changes in telehealth made during the pandemic. This is crucial because without financial incentives to further expand telehealth, health care providers can return to a pre-pandemic approach. “One issue, which is important for health and non-health people to know, is that telehealth will continue to expand dramatically as long as there are funds and compensation for it,” said Michael Dowling, president and CEO of Northwell. “If insurance companies and the government decide, ‘We don’t want to pay for telehealth in the future or virtual visits,’ then it will slow down. If there is no delivery system, no health system, no hospital, no doctor. They will continue to expand telehealth if they are not reimbursed.” However, some of the largest insurers in the state have already stopped giving up telehealth fees and payments to some customers, although the pandemic has no clear end. The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, at parity, up and down the chain, and passing a federal law requiring self-insured health plans to pay for telehealth services as well as personal visits. Telehealth has been shown to work for emergency care, primary care and some special care and clearly expands access to behavioral health care, Doerfler said. “Some have said that the cost of providing telehealth is lower than it face to face, but most costs are unchanged and new ones are added with technological requirements. When a patient receives a very specific service, there are billing codes define that service. If the service is smaller, the code represents it.If the service is the same, the code will represent it and should be paid for at parity. ”Doerfler added that while telehealth cannot replace all traditional health care services, it should be“ in the tool ”for patients and doctors. “In the modern world, where this type of technology is used for all kinds of personal and business uses, excluding such personal care as your concern between you and your doctor from fitting into that modern paradigm makes no sense,” Doerfler said.