Written By: Kayla Cross, Nurse Practitioner, Women & Infants Center for Primary Care on September 20, 2021
The year 2020 brought about much uncertainty. Silver linings have been hard to come by, but the expansion of telemedicine services (also referred to as Telehealth) is a notable addition to primary care.
Telemedicine Evolution
Telemedicine, defined in The Telemedicine Coverage Act of Rhode Island (H 7160B) as clinical health care services delivered using real-time two-way electronic audiovisual communications to provide or support health care delivery to assess, diagnose, treat and manage the care of patients, is not a new concept. The laws as currently practiced were enacted as of January 1, 2018.
Starting March 6, 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily expanded service coverage on an emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits were enacted to, “ensure that all Americans, particularly those at high risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (CMS, 2021). Prior to this waiver, Medicare reimbursement for telehealth occurred only on a limited basis.
Benefits of Telemedicine
Telemedicine services function not only in the age of COVID-19 but fill a need for patients who may have medical conditions or life situations that inhibit physical access to our offices. When introducing the Telemedicine Coverage Act, lawmakers cited geography, weather, availability of specialists, and transportation as barriers to accessing the appropriate health care, including behavioral health care (The Telemedicine Coverage Act, 2016).
By breaking down these physical barriers to care, patient contact and continuity of services can be maintained. The more closely we can communicate with patients on all platforms, the easier it is to provide excellent follow-up care and assure optimal health outcomes. A 2020 Cochrane Review authored by Drs. Rubinger & Bhandari found that interactive telemedicine in the management of chronic health conditions was equivalent to usual practice. The review did discuss that cost implication and acceptability from patients and healthcare practitioners have not yet been established.
Limitations of Telemedicine
Telemedicine does have its limitations. Difficulty with and resistance to fitting telemedicine into routine practice, complications in the interaction between healthcare professionals, inconsistent patient satisfaction, patient access to the internet and internet-capable devices, ethical concerns, and patient abilities/disabilities all may preclude the use of telemedicine services (Rubinger & Bhandari, 2020). Not all complaints are suited for virtual visits.
The Future of Telemedicine
I can only assume that telehealth is here to stay. I have personally noted an improvement in compliance with follow-ups, eased access to care, and patient willingness to utilize telemedicine services. As time has passed, some restrictions on the execution of telemedicine have been placed, including licensing and location of providers/patients, as well as the use and means of the platform of consent. Collecting retrospective data from pre and post COVID allowances for expanded utilization could prove its effectiveness and solidify its equal reimbursement in health care long term.
