The telemedicine genie is out of the bottle

Times of crisis have a way of opening new horizons. Policies once deemed drastic become plausible and necessary. The coronavirus pandemic has revealed a host of such opportunities, but perhaps none so groundbreaking as that of telemedicine.

Telemedicine – including Medicare telehealth and other related services – allows patients to visit with clinicians remotely using virtual technology. Modernizing Medicare and giving seniors access to the latest telemedicine technology as part of CMS’ Fostering Innovation Initiative was a priority for the Trump administration long before the coronavirus struck. However, the exigencies of the pandemic substantially accelerated our efforts.

In some cases, using existing authority and in others capitalizing on congressional authorization in pandemic relief legislation, the Centers for Medicare & Medicaid Services (CMS) took early action to topple regulatory barriers for seniors and others with Medicare, who can now have an “office” visit from home. For the duration of the COVID-19 public health emergency, Medicare has added 135 new virtual services, such as eye exams and ventilator management. We allowed for telemedicine in different settings, including the patient’s home and drastically expanded the list of eligible providers to include physical therapists, occupational therapists, and more.

We also removed face-to-face requirements for certain types of care, instead allowing many to take place over the phone. Medicare patients can even make a “visit” to the emergency room remotely. Thanks to the flexibilities CMS offered them during the public health emergency, many plans in the privately administered Medicare Advantage program, which serves over 24 million beneficiaries, increased their slate of telemedicine services and waived or reduced copays.

Two months in, the telemedicine push has proven a lifeline, giving seniors and others access to health care without increasing their risk of exposure to the COVID-19 virus. It served as a bridge to connect health care providers to patients amid stay-at-home orders. The result was accessible care for patients and a revenue source for providers who willingly delayed non-essential elective surgeries and procedures.

Never before has the health system adapted so rapidly to any change, especially one that so dramatically transforms how care is delivered.

Since mid-March, over 9 million beneficiaries have used telemedicine in traditional Medicare, an over 5,000 percent increase from the prior three months. 5.8 million of those received a common office visit via telemedicine. In other words, millions of Americans received convenient care from the comfort of their home while avoiding unnecessary exposure to the virus. By the same token, countless providers were also protected from exposure, and scarce personal protective equipment was preserved for health care providers hard-pressed by the virus.

Preliminary data also show that 60 percent of beneficiaries receiving telehealth-eligible psychiatric and psychological services during the public health emergency, are doing so via telehealth, including by phone. This proliferation of mental health counseling and psychiatry to patients in their home – and its continuation on a more regular basis – promises to make this care more accessible and palatable for patients, reducing the stigma too often associated with mental health.

Given this resounding success, CMS is working to extend the availability of certain telemedicine services beyond the duration of the emergency with appropriate oversight to protect against waste, fraud, and abuse. Telehealth has shown that it can allow patients to connect with medical specialists in short supply. There is little reason to unduly confine this advantage to time of pandemic.

I want to emphasize that telemedicine can never fully replace the gold standard: in-person care. Physicians will always need to listen to their patients’ heart and lungs; children will always need their vaccinations; and adults can go only so long without cancer screenings.

But what telemedicine certainly can do is complement and enhance traditional in-person care by furnishing one more powerful clinical tool. Many Medicare patients, regardless of whether they live in rural, urban, or suburban areas, find it difficult to travel to a doctor’s office. Some rely on caregivers or family to get them there at all; telemedicine puts patients back in control of their care.

In an earlier age, doctors often made house calls. In today’s busy world, telemedicine is poised to resurrect them in a modern form, providing affordable, personalized care. In light of the pandemic we are all living through now, it’s difficult to see why government policies should stand in the way of such common-sense convenience as long as taxpayers are vigilantly protected.

While the Trump administration is doing everything it can to make many of our changes permanent through regulatory action, Congress needs to help by following through on its actions on this issue during the pandemic by amending the law. Specifically, Congress should relax requirements that prevent Medicare beneficiaries from receiving care in their own home or outside of rural areas and allow for telemedicine to be furnished across state lines while protecting taxpayers.

Now that patients and clinicians have had a taste, the appetite for enshrining the Trump administration’s expansion of telemedicine in law will never be greater. It has taken a crisis to push us to this new frontier; Congress should not let us go back.

Seema Verma is administrator of the Centers for Medicare and Medicaid Services and a White House Coronavirus Task Force member.


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