Telehealth – A Silver Lining
I remember the first time I drove a car with a backup camera. I rented a car for five days and quickly became very comfortable and impressed with how useful the camera was and how it helped me feel safe as I backed up and parked. The first time I drove my car after I returned home, I was amazed at how I instinctively looked at the dashboard when I backed up, searching for the backup camera screen that my car still didn’t have. In just five days, I had grown used to this new technology that was effective, efficient, and made my life easier and safer. I think that the same thing happened during the pandemic with telehealth.
Usually, it takes years of research and costly trials to bring a new medicine or technology to market. We have all witnessed how slow our government moves as it adopts new treatments or new ways to administer our care. Medicare is especially slow when it comes to figuring out how to pay healthcare providers for improvements to our care.
The COVID-19 emergency did have some silver linings. First, it showed the world that we could take a breakthrough scientific discovery that had been under development for 10 years and use it to produce lifesaving vaccines. In record time, we developed, tested, manufactured, distributed, and, surprisingly, quickly figured out how to pay for it. It saved millions of lives. Second, because of the need to isolate ourselves to prevent the virus spread, the government quickly changed regulations and allowed patients to use telehealth to communicate with their doctors. It allowed many of us to get our doctor’s guided care which, along with preventing the spread of the virus, no doubt saved many more lives.
The unique thing about this pandemic emergency is that it forced us to quickly adopt telehealth. Doctors and hospitals were forced to quickly install technology and support telehealth. They had to learn how to effectively diagnose and advise patients without having physical access. It also required us, the patients, to become comfortable with this way of providing care. In essence, it turned our whole country into medical trial participants to prove the worth of telehealth. From my point of view, it accelerated the acceptance and use of telehealth by years if not a decade.
I do want to point out another silver lining . . . the sudden advancement of older Americans in their use of video conferencing. As we age, seniors aren’t very keen on learning a lot of new things. The “old dog, new tricks” thing. When the pandemic hit people were warned, especially the older population, that we shouldn’t venture out and expose ourselves to other people. This meant not visiting our kids and grandkids. If you want to motivate seniors, tell them they will have to learn another way to see and talk to their grandkids. Suddenly these seniors, who their children had labeled technical midgets, became Zoom knowledge giants. While Medicare focused on using only audio capabilities, I personally know that many used video to show rashes and other physical abnormalities to aid in the diagnosis. I am sure the additional incentive to learn how to conference with a PC added to the speed of the adoption of telehealth and greatly increased our comfort in using it.
So . . . It’s been five years, how have our lawmakers taken advantage of this silver lining gift. The clearance to use telehealth was granted under emergency powers legislation, i.e., the CARES Act, the Consolidated Appropriations Act, and Public Health Emergency Declarations, which waived certain regulations, but all of these were temporary. Congress extended these laws and regulations last year and just this month, thank goodness, they extended them through September 30th. They also extended the temporary waiver to prescribe most medicines over the phone to the end of this year. These extensions are great, but they are all short-term. It seems our lawmakers are hesitant to accept the fact that telehealth is efficient and economical and should be made a permanent part of our healthcare.
I realize that telehealth opens the door to fraud and abuse. With a shortage of primary care doctors looming, using telehealth to treat more patients in a day could ease this shortage, to say nothing of eliminating the travel requirements of the patient. Unfortunately, that same fact opens the door to fraud and abuse with the possibility an unscrupulous doctor could turn her/his office into a factory of quick calls, easy prescriptions, and unneeded referrals. It does seem, however, that with five years of experience and data, the Centers for Medicare and Medicaid Services (CMS) could create the appropriate guardrails to regulate and ensure the proper use of telehealth.
With the rapid creation of technology that can monitor and even treat patients in their homes, telehealth isn’t the only remote treatment option that our lawmakers will need to consider in the near future. The cost savings that could be realized by pushing many procedures out of the hospital is huge. Our lawmakers can’t continue to kick these efficient solutions down the road. They need to carefully consider how providers made the best use of telehealth and where its use saved money. They need to recognize what a positive effect it had on patient’s access to healthcare, especially those living in rural areas. They need to look at the data gained in the last five years and decide what guardrails need to be installed to ensure safety and the proper use of telehealth. It’s a task that should have bipartisan support, but it needs to be done before the temporary extensions run out at the end of September.
Best, Thair