Spivak realized she could leverage her expertise and clinical skills. Patients can discuss their health in a way that is sometimes better than if they were sitting face to face. Even the phone allowed for “incredible, really good care.”
Now president-elect of the Massachusetts Medical Society, Spivak is worried about the future of telemedicine as patients return to the office, rules change again, and insurance companies begin to cut telemedicine payments. one of the many doctors
By all accounts, telemedicine is here to stay. But what form it will take in the end is an open question. Primary care physicians run “hybrid” offices, typically 5-15% of visits are done by video or phone, but the optimal percentage of remote visits and when to visit in person is important It is not yet clear whether Healthcare providers also face uncertainty about how to pay for telemedicine visits.
“We are at a crossroads,” said Dr. Philip Ciampa, medical director of digital health at Atrius Health, a large group practice in eastern Massachusetts. “You can imagine how much teamwork and effort went into this.
Legislators and regulators have enabled the telemedicine pandemic explosion by abandoning many previously impeding regulations and policies. For example, insurance companies had to pay remote visits the same amount as in-person visits, allowing doctors to easily treat people across state lines.
These waivers have expired and many insurers have reverted to paying 80% of personal rates for primary and chronic care. (For behavioral health, state law requires providers to receive the same pay for remote sessions as they do in person.)
Additionally, doctors are no longer physically able to conduct remote sessions with patients It is in a state where doctors are not licensed, adding barriers for New Hampshire patients who have doctors in Boston and Massachusetts residents who spend the winter in Florida. , with different requirements and fees, which is a considerable burden.
Providers were encouraged when the Blue Cross Blue Shield of Massachusetts recently pledged to continue paying for telemedicine in full indefinitely. State Medicaid programs also pay the same amount for in-person and remote visits.
The federal Medicare program still covers the cost of telemedicine, but will end in December 2024, except in remote rural areas.
Dr. Lee H. Schwamm, vice president of digital patient experience and virtual care at Mass General Brigham, said that this uncertainty could lead to real cost-saving measures for physician practices, such as investments in new technology and office space. ) are becoming more difficult to implement.
“If you have a clear path where refunds are known to be permanent, you can get savings out of the system,” Schwam said.
Point32Health, the state’s second-largest insurer, has started paying 80% of in-person rates for telemedicine. proposed law Telemedicine coverage will be required at the same rate as in-person visits for primary and chronic care.
Claire Levesque, Ph.D., Chief Medical Officer for Commercial Products at Point32Health, says telemedicine is “really for low vision episodes that don’t require much in terms of physical demands.”
Dr. Claire Levesque, chief medical officer for commercial products at Point32Health, says telemedicine is less expensive, so it makes sense to reduce reimbursements. Patients measure their own blood pressure, and the medical assistant does not need to prepare the room.
But doctors say they are spending money to maintain a “hybrid office.” Medical assistants are still needed for online visits, arranging meetings, collecting vital signs, and reviewing medications with patients.
“In many ways it’s more complicated,” says Spivak. If a patient requires a follow-up test, it can be arranged on the spot after an in-person appointment. A remote visit requires the medical assistant to call back and set up the patient.
Atrius Health’s Ciampa said the growth in telemedicine has not lowered operating costs. “The cognitive tasks should be the same, the time should be the same, the reward should be the same,” he said.
But some who are concerned about healthcare costs say they have had plenty of time for providers to upgrade their systems, learn how to use them, and realize the savings.
Eric P. Gurko, president of Innovo Benefit Group, a brokerage firm for small businesses, said providers who aren’t saving money should talk to others who understand it. At some point, we need to leverage this telemedicine tool to lower health insurance costs in the long run,” he said.
Joshua Archambault, Senior Fellow in Healthcare Policy at the Pioneer Institute, a free-market think tank, calls for data-driven decision-making. Blue Cross made a full commitment before seeing when telemedicine would be most effective, he said. Instead, he said, insurers should “pay for what works and stop paying for what doesn’t.”
According to Archambault, reimbursement rates aren’t just an argument between providers and insurers; ultimately, it’s the patient who pays. Most people who work for small businesses have plans with high deductibles and rarely exceed the deductible, so the increased reimbursement amount will come directly out of many patients’ pockets, he said.
Still, it’s clear that patients love telemedicine, whether it saves them money or not.a investigation Massachusetts Health Quality Partners found that 89% of patients say their telemedicine experience will be “excellent” or “very good” in 2021. By 2022 he has dropped to 81%.
The main reasons for the change were the inability to access telemedicine across state lines, the inability of many providers to provide telemedicine at the patient’s request, and frustration with unstable technology.
Among physicians, the survey showed the opposite trend. In 2021, 43% had an excellent or very good experience. By 2022, that will increase to 58% as technology improves and comfort increases.
Spivak said he was initially worried he might miss something because he hadn’t seen the patient, but that never happened. It actually made checking medication easier when patients could collect all the bottles and line them up on the kitchen counter.
Telemedicine started as a way to provide care to people in remote areas, but getting to an urban clinic can be difficult. Dr. Julita Mir, chief medical officer of her DotHouse Health, a community health center in Dorchester, said telehealth could help patients who are having difficulty raising children, who are stuck at work, or who rely on public transportation. It will be easier to access for patients who are
“Sometimes I see patients waiting in the waiting room for an hour and a half on two buses.
Peering into a patient’s home can deepen the encounter, says Mir. Pediatricians witness young patients playing in a more relaxed environment. For older patients, telemedicine allows doctors to interact with family members.
But some patients have poor broadband access or limited mobile phone talk time, Mir said.
Kestrel Berlager, an advocate for access to technology for people with disabilities and the elderly, says telemedicine still has a long way to go to meet the needs of these groups. Many telemedicine programs are not properly formatted for use by a blind person like her who uses her screen reader. Some senior housing estates don’t have her Wi-Fi. “We should be talking about health instead of emphasizing whether or not you have access to the link,” she said Verlager.
Dr. Joseph Kvedar, the former president of the American Telemedicine Association, said telemedicine will ultimately be used for simple interactions, such as checking how a drug works or showing test results. It is predicted that it will be done.
“Who likes to drive two hours, park in the garage, wait in the waiting room, wait in the lab, and spend five minutes with a specialist?” he said. His dermatologist, Kvedar, said he used telemedicine to treat his teenage patients in the locker room between games. That’s the convenience patients expect, he said.
Felice J. Freyer can be reached at [email protected]. follow her on her twitter @felicejfreyer.
