The pandemic elevated the acceptance of telemedicine. Both physicians and patients recognized its abilities during the times of quarantine- approaching some 32% of all office and outpatient health encounters. I really thought this could be the boost the technology needed to turn the corner. (I’ve been advocating telemedicine for 40 years- always expecting it to take off.)
After all, folks who live in the middle of nowhere (ok- they are officially called remote communities), nursing homes, even in low-income neighborhoods would finally have adequate access to healthcare. Not to mention affording practitioners to see the actual conditions of patient living, to better understand what may or may not work to keep them healthy. And, health care professionals would not be bound by state lines- the Interstate Medical Licensure Compact, became the norm, rather than the exception. (The compact streamlines the process to obtain multiple state licenses.)
During the pandemic (some 18 months and still going), health care professionals managed to employ the new rules to use phone and internet services to provide direct health care to their patients. (Admittedly, if this manages to continue, we will need to up the security component of these virtual visits.)
One of my favorite places (Vinal Haven, an island some 15 miles off the coast of Maine)- where on-site water treatment and reuse kept me involved there some 46 year ago- is a prime example. Given its remote locate, the Island Community Medical Services (ICMS) catered to the 1500 year-round residents, providing both behavioral care and primary care. The Maine Seacoast Mission (which operates a 75 foot floating boat clinic, the Sunbeam V) is used to coordinate with out-of-state specialists (physicians at Mass General in Boston, as well as with mainland practitioners).
The public health emergency (COVID-19 Quarantine) erased all the barriers to expansion and the ICMS jumped at the opportunity, including payment for telehealth services for the first time. After all, patients were well-served by the telemedicine services. Instead of traveling for hours- and waiting even longer to see their doctor- patients can simply stop work (or take a short spell at home) for the 15 minutes to half an hour visit and receive their practitioner’s care.
The Biden administration has authorized some $ 19 million to be spent on telehealth access in remote areas. (Part of this has already gone to MaineHealth, which includes the VinalHaven system, which will use the funds to promote benefits for home diabetes treatment and care.)
Except…
States are allowing their emergency orders affording free reign to telemedicine to lapse. They aren’t waiving out-of-state medical licenses. Telemedicine costs are not being covered. (Medicare will terminate payment for telehealth on 18 October 2021 [Xavier Becerra, Secretary of HHS order].)
It may be that the behavioral sciences have progressed too far for those benefits to be repealed. Which explains why CMMS (Center for Medicare and Medicaid Services) took its tack in the 2022 Medicare Proposed Physician Fee Schedule.
Only some of the telemedicine charges will be reimbursed by Medicare (mostly for behavioral services). For example, Medicare will require a non-telemedicine visit for mental health services within 6 months prior to any covered telemedicine visit- and this requirement repeats every six months. (For those patients who lack internet service- or won’t so consent- the agency will allow audio only visits.)
Yet, there is hope for telemedicine services. Congress is considering a bill to make the temporary provisions permanent. (It is pretty clear to anyone watching Congress that this bill will NOT pass before the expiration of the temporary measures- if at all. Assuming the infrastructure bill passes, the $ 65 billion authorization for broadband expansion will certainly help telemedicine along- including the collection of data from wearable medical devices.)
Will we see these convenient- and effective- services disappear?
