{"id":28611,"date":"2020-09-02T20:21:08","date_gmt":"2020-09-02T20:21:08","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28611"},"modified":"2020-09-02T20:21:08","modified_gmt":"2020-09-02T20:21:08","slug":"is-telemedicine-here-to-stay","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/is-telemedicine-here-to-stay\/","title":{"rendered":"Is Telemedicine Here to Stay?"},"content":{"rendered":"\n

The answer largely depends on whether Medicare and private health insurers will adequately cover virtual doctor visits once coronavirus outbreaks subside.<\/p>\n\n\n\n

Telemedicine is having its moment. Over the last few months, millions of people have relied on video or telephone calls to talk to their doctors. But as the pandemic moves across the United States, and eventually recedes in some places, how long will the moment last?<\/p>\n\n\n\n

While patients used virtual visits to avoid overcrowded and potentially infectious doctor\u2019s offices or emergency rooms, many are returning to face-to-face appointments in cities where the threat has subsided.<\/p>\n\n\n\n

And insurance payments for telehealth services, especially at full cost, may only be temporary.<\/p>\n\n\n\n

Medicare\u2019s coverage of a broad range of services is slated to end when the coronavirus no longer poses a public health emergency. Private insurers, which followed the federal government\u2019s lead, could revert to paying doctors for virtual visits at a fraction of the cost for traditional visits, if anything at all.<\/p>\n\n\n\n

Some of the nation\u2019s biggest insurers, like UnitedHealthcare and Anthem, say they haven\u2019t decided beyond September or October on whether to extend the policies they adopted that allowed for coverage in lieu of doctors\u2019 visits during the coronavirus crisis.<\/p>\n\n\n\n

\u201cThe concern everyone in the industry has is that reimbursement is in jeopardy,\u201d said Dr. Mia Levy, the director of the cancer center at Rush University Medical Center in Chicago, which treated patients virtually during the height of the pandemic. \u201cBecause of telehealth, we were able to stay actively engaged with our patients,\u201d she said.<\/p>\n\n\n\n

While there is broad bipartisan support for telehealth coverage, Congress would have to pass specific legislation to make some of Medicare\u2019s changes permanent.<\/p>\n\n\n\n

\u201cReversing course would be a mistake,\u201d said Seema Verma, the administrator for the federal program, which reimbursed doctors the same for virtual visits, including those over the telephone, as for in-person ones and relaxed rules about who can use telemedicine.<\/p>\n\n\n\n

About nine million people under traditional Medicare <\/a>used telemedicine services during the early months of the crisis. Early data does not show wide variations in use by race or ethnicity.<\/p>\n\n\n\n

\u201cIt was really a no-brainer for us,\u201d Ms. Verma said.<\/p>\n\n\n\n

And spending on telemedicine services during the first peak of the coronavirus pandemic in the United States underscores the demand. In addition to federal spending through Medicare, nearly $4 billion was billed nationally for telehealth visits during March and April, compared to less than $60 million for the same two months of 2019, according to FAIR Health, a nonprofit group that analyzes private health insurance claims.<\/p>\n\n\n\n

But to convince insurers they should continue paying for virtual care, doctors must demonstrate they can move beyond treating simple respiratory infections to caring for patients with chronic conditions like depression or diabetes. \u201cFrom the perspective of managing the cost and quality, there\u2019s a lot we don\u2019t know about telemedicine,\u201d said Dr. Rahul Rajkumar, the chief medical officer at Blue Cross Blue Shield of North Carolina.<\/p>\n\n\n\n

BlueCross BlueShield of Tennessee says it is the first major insurer<\/a> to make coverage of telehealth services permanent, but it has not yet determined how much it will eventually pay for the care. A few insurers, including Cigna and the Blue Cross plan in North Carolina, said they will continue to cover telehealth services at pandemic levels through the end of the year.<\/p>\n\n\n\n

\u201cWe need to give providers time to get more comfortable,\u201d said Dr. Scott Josephs, the chief medical officer for Cigna. To make remote medicine successful and worthwhile, doctors and medical groups need to invest in technology and train staff. \u201cIf they don\u2019t have the time, they won\u2019t make the investments,\u201d he said.<\/p>\n\n\n\n

The biggest hurdle to widespread adoption by both the government and insurers is the potential cost.<\/p>\n\n\n\n

Lawmakers are reluctant to pass any bill that would significantly add to Medicare\u2019s budget, with the government already spending a total of some $750 billion a year.<\/p>\n\n\n\n

And private insurers see telemedicine as a way to save them money, said Sabrina Corlette, a research professor at Georgetown University, who helped author a recent report<\/a> on how the companies responded to the pandemic. \u201cUnless they are required to by the states or federal government, a lot of carriers will try to reimburse less for telehealth than an in-person visit,\u201d she said.<\/p>\n\n\n\n

For those at risk, telemedicine is particularly valuable. When a fever sent Susan Varak, 45, who has breast cancer, to the emergency room during the height of Chicago\u2019s outbreak in April, she felt as if she were \u201cwalking into this war zone,\u201d she said, because she was so terrified of catching the virus.<\/p>\n\n\n\n

She appreciates she still can see her oncologist remotely. \u201cI don\u2019t think it\u2019s absolutely necessary to be face-to-face every couple of weeks,\u201d she said.<\/p>\n\n\n\n

Other patients like the convenience. David Collins, 67, didn\u2019t have a choice when he had a 20-minute video visit in March to rule out a diagnosis of coronavirus. Like many practices during the pandemic<\/a>, the Kelsey-Seybold Clinic, a large physician group in Houston, was not allowing most patients to come in.<\/p>\n\n\n\n

\u201cI loved it because it saved me a lot of time.\u201d he said, adding \u201cI\u2019d much rather do that than drive across town and look for parking.\u201d<\/p>\n\n\n\n

But, a few months later, he didn\u2019t hesitate to go to the clinic for his checkup. \u201cThere\u2019s a little more hands-on required,\u201d he explained, like getting a physical exam and having his blood pressure taken. Not everything can be done virtually, he said. \u201cIf you break your arm, an e-visit isn\u2019t going to help you at all,\u201d he said.<\/p>\n\n\n\n

After seeing about 90 percent of its patients virtually, Kelsey-Seybold has \u201calmost flip-flopped back,\u201d said Dr. Donnie Aga, an internist who oversees telehealth for the group. Most patients seem to prefer an in-person appointment. \u201cYou could really see that people missed coming in,\u201d he said.<\/p>\n\n\n\n

With coronavirus cases now at epidemic levels in Texas, the clinic wants to shift to dividing visits to half virtual, half in person. \u201cYou\u2019ve got to have a balance, for sure,\u201d Dr. Aga said.<\/p>\n\n\n\n

But how doctors and insurers can do that is still unknown.<\/p>\n\n\n\n

\u201cWe need to see where the equilibrium ends up,\u201d said Dr. Andrea Gelzer, the corporate chief medical officer for AmeriHealth Caritas, a Medicaid managed care company. \u201cIf the total number of visits far exceeds pre-Covid, I don\u2019t think that\u2019s sustainable,\u201d she said. Additional visits that do not improve patients\u2019 health will only result in higher costs.<\/p>\n\n\n\n

Doctors have to be more discriminating about which patients to see remotely, said Rita Numerof, a health care consultant.<\/p>\n\n\n\n

Telemedicine \u201cwas a solution to an immediate problem,\u201d she said, and doctors did not have clear criteria about who should be seen, under what circumstances and for which conditions.<\/p>\n\n\n\n

Many in Congress are already convinced that Medicare should continue the current coverage. \u201cThe Covid-19 pandemic has been a trial by fire, but the experience to date has made clear that the health care system is ready for broader access to telehealth on a permanent basis,\u201d said Sen. Ron Wyden of Oregon, a Democrat who introduced legislation earlier this month.<\/p>\n\n\n\n

On Thursday, Sen. Lamar Alexander of Tennessee, a Republican and chair of the Senate health committee, introduced the Telehealth Modernization Act, which would also make some changes permanent. The experience of the previous four months \u201cwill likely mean that hundreds of millions of physician-patient visits will be remote or online that were in-person before,\u201d he said.<\/p>\n\n\n\n

Since May, nearly 20 telemedicine bills have been brought to the House floor and about the same number in the Senate, said Miranda Franco, a senior policy adviser for the law firm Holland & Knight. She thinks legislation will be passed by the end of the year.<\/p>\n\n\n\n

While some lawmakers favor permanently expanding Medicare payment for a broad range of telemedicine services, others are concerned about the technology\u2019s cost and potential for fraud. \u201cNow you\u2019re talking about reimbursing services we haven\u2019t reimbursed before,\u201d Ms. Franco said.<\/p>\n\n\n\n

Some patients say telemedicine is not a substitute for in-person care. Jorge Cueto, who is in his mid-20s, said a virtual visit is often an additional step before going to the doctor\u2019s office for, say, a sore throat.<\/p>\n\n\n\n

\u201cIt\u2019s another fee, it\u2019s another gating mechanism,\u201d he said.<\/p>\n\n\n\n

His parents, who are not fluent in English, prefer going to the doctor\u2019s office because they find it easier to communicate in person, he said, and they have difficulty setting up video calls. \u201cI don\u2019t think they would be willing opt for telehealth if they weren\u2019t required to do it,\u201d Mr. Cueto said.<\/p>\n\n\n\n

Others may not have access to a computer or smartphone to connect for video visits, and insurers are particularly wary of doctors charging for phone calls to follow up on lab results or tell someone to come to the office.<\/p>\n\n\n\n

Even patients who have cellphones may not be able to afford a lengthy consultation, Dr. Levy said. She and her colleagues discovered some people stopped answering their phones at the end of the month because they had run out of minutes. \u201cThat was very eye-opening to us,\u201d she said.<\/p>\n\n\n\n

Some proponents argue the goal of telemedicine should not be to lower health care costs over all. One of its main benefits is improving patients\u2019 access to care, said Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School, adding that it would be foolish to expect savings if more people also get treatment. \u201cThose don\u2019t reconcile,\u201d he said.<\/p>\n\n\n\n

Insurers should evaluate whether telemedicine is more effective for treating conditions like depression than it is for, say, cancer. They could then make those distinctions in reimbursing for virtual visits, he said, just as they do for different prescription drugs.<\/p>\n\n\n\n

\u201cThere should be no single telemedicine policy,\u201d Dr. Mehrotra said.<\/p>\n","protected":false},"excerpt":{"rendered":"

The answer largely depends on whether Medicare and private health insurers will adequately cover virtual 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