Why Can’t Our Government Accept the Gift of Telemedicine?

If you ask anyone about their experiences during the COVID pandemic, you’ll no doubt hear about people they knew who were very sick and even some who lost friends. You’ll hear about the quarantining, the loneliness, the lost chances to see their kids and grandkids. I’m not sure anyone will talk about anything positive that came out of that experience except, maybe one thing – the change in the rules that gave us the gift of expanding the use of telemedicine.

Historically, healthcare has adopted new technology slowly. While there is a proven path for the safe approval of medicines, the approval of new medical devices, new home monitoring systems, even the new software that runs these devices is often ill defined. Every year I go to the Consumer Electronics Show (CES) to review and report on new healthcare technology. It is always an amazing experience, and I find myself wondering why some of the new things I see are not already being incorporated in the current standards of care. There have always been barriers that confront final acceptance of many of these technological solutions. One big one has been maintaining the privacy of personal health information, which is governed by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While these rules were absolutely necessary, they were mostly done for paper-based systems and for the initial types of automated transfer of health information. It has led to some unique, sometimes outdated ways to deal with these requirements. There are still practices that fax information as way to preserve data security and comply with HIPPA. The preservation of health information privacy has become even more complicated with the ability to transfer large image files and the increase in hackers that want to sell the information or blackmail institutions. These privacy concerns were part of the adoption problems faced by telemedicine, but its use was slowly moving forward.  

Before the pandemic telemedicine was gradually being incorporated into certain areas of care, primarily mental health, substance use disorder, stroke evaluation, and dialysis follow-ups – but before it could expand there were barriers that had to be dealt with. Doctors were even hesitant, for good reason. They got information about a patient from observation and the direct gathering of symptoms. Talking on a telephone just left a lot to be desired, it was called telemedicine after all. There wasn’t training in med school on telemedicine. Medicare had problems coming up with a way to pay for this type of care. Everyone could see this approach opened the door for fraud and abuse. All of these obstacles led to the slow adoption of telemedicine.

An ancient proverb was the basis for the saying that evolved to be, “necessity is the mother of invention.” I think this certainly applies to the lightning-fast development of a COVID vaccine and to the decision to pass legislation that greatly expanded the acceptance of, and allowed the payment for, the use of telemedicine during the pandemic. We couldn’t see our doctors or other healthcare providers in person for fear of spreading the virus, but our health problems didn’t stop because of the pandemic - if anything they were magnified. We were forced to figure out how to adapt. There were a couple of things in our favor. The availability of fast internet had expanded exponentially and we, especially us older people, had begun to figure out how to use Zoom for face-to-face visits to our friends and family. This gave us the tools to better use remote healthcare. It wasn’t easy at first, but doctors and other providers quickly adapted to interacting and efficiently gathering the necessary health information. This allowed us to exchange critical data that helped physicians determine the best course of action. We were forced to learn how to use this different form of healthcare and we found out it really did work. It was a gift that the pandemic gave to us.

While the legislation that granted the expanded use of telemedicine was part of the emergency response to the pandemic, its expanded use highlighted how efficient and valuable this form of healthcare could be. While it was initiated primarily to avoid spreading the virus, it kept rural patients from traveling large distances to obtain care, people didn’t have to get from work, arrange for childcare, or arrange for transportation. It has continued to prove its value by helping us avoid the germs that accumulate in doctor’s office waiting rooms. It just makes sense. So, what’s the problem? Glad you asked.

The legislation that granted the expanded use of telemedicine expired on September 30, this year. There were many attempts to have it made permanent or, at the very least, to get it extended for a year or two. It had bi-partisan support and seemed to be on the road to being reauthorized. For many reasons, none of which I think were valid, it didn’t get done and the expanded access to telehealth stopped on October 1st. It just didn’t make sense to let it expire and I guess enough lawmakers felt the same way because it got reauthorized in the legislation that ended the government shutdown, but that legislation only got the expanded use of telehealth extended until January 30th 2026. That just isn’t going to work, we need to take advantage of one of the few gifts COVID gave us.

Tell you lawmakers that we need to make this efficient, cost-saving, patient focused way of providing healthcare permanent. It’s a gift that we just can’t refuse.

Best, Thair