In 1968, Dr. Kenneth Byrd made history by creating a microwave link from Massachusetts General Hospital to Logan Airport. He used that link and what was at the time state-of-the-art videoconferencing to conduct patient visits without traveling to the Logan Airport health clinic. Many historians credit Byrd with coining the term “telemedicine” to describe this mode of health care delivery. In the ensuing 50 years, we have progressed by fits and starts, as telehealth has succeeded in pockets (e.g., military applications and the Veterans Administration) but lagged in virtually all other settings. The key barriers to adoption have been patient reluctance to use technology and lack of reimbursement for physician services.
As we grapple with containing the spread of the coronavirus, which can be boiled down to “stay at home and stay away from others,” it appears that telehealth is poised to become a much more significant part of care delivery.
▪ Most consumers are now comfortable using popular apps such as FaceTime or Skype to video chat with loved ones, making the leap to video chatting with your doctor much easier.
▪ Smartphone adoption is nearly ubiquitous, giving us a common platform for telehealth.
▪ Every other service we consume — from banking to shopping for groceries ― leverages a digital entry point and celebrates delivering service without human contact.
▪ When screening patients for the coronavirus, health care providers base decision-making mostly on history-taking, asking the patient to answer a series of questions. This easily transfers to a virtual care delivery platform.
▪ Thanks to the recent executive order from Governor Baker, health plans are now required to reimburse health care providers for telehealth at the same rate as for an in-person office visit. The US Centers for Medicare and Medicaid Services (CMS) also announced expanded Medicare telehealth coverage, waiving several restrictions for telehealth, and moved to reimburse for telehealth visits to Medicare patients during this emergency. While the initial intent was to reimburse for video calls, in Massachusetts both private insurers and Medicaid will also reimburse for phone calls. While not official, it seems that Medicare is moving in this direction as well. This is undoubtedly due to the reality that many of the most at-risk population (over 65) aren’t technologically comfortable with video call technology.
▪ Perhaps the most significant development in transforming care delivery is that, because the majority of us will be confined to home for the forseeable future, doctors are starting to address non-coronavirus-related medical issues via telehealth.
Can you expect to get care via telehealth in the coming weeks? It depends. Your doctor’s office may have already started to move your nonessential care to a virtual platform. All of the large health care systems in the Boston area are rapidly implementing telehealth programs,for coronavirus-related illness care as well as other follow-up care. Check your provider’s website or, as a last resort, call. (Every provider is now inundated with phone calls.)
There are other resources. Health plans have coronavirus-related information on their websites, and most have sections related to telehealth to connect you with a telehealth provider. Also, the largest direct-to-consumer telehealth companies (e.g., Teledoc Health, MD Live, and AmericanWell) are offering access to services via their websites. With these options, make sure the records from your virtual visit are shared with your doctor for continuity of care.
In the next several weeks, we will learn just how much our health care system can practically deliver via telehealth. Based on nearly 30 years of experience, I suspect it will be a lot. Patients will grow fond of the convenience of telehealth. Will we easily go back to the “pre-coronavirus” way of face-to-face visits at a hospital or doctor’s office to access routine care? Probably not. We will become used to a new reality. In this case, one that is more convenient.
What will it take to sustain this trend toward virtual care delivery? Several policy decisions come to mind, including making permanent some of the flexibilities being put in place by the government to address the coronavirus. Waiving restrictive physician licensure laws that now severely inhibit cross-state care delivery by telehealth would be another.
This is no doubt a challenging time, but if thoughtful, we can usher in a new era of care delivery that is high quality, efficient, and patient-friendly.
Dr. Joseph C. Kvedar is president-elect of the American Telemedicine Association and professor of dermatology at Harvard Medical School.
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