BY CHERYL M. KEYSER
As the U.S. population ages, more and more patients are dealing with chronic care issues - diabetes, heart disease, osteoporosis, Parkinson’s, to name a few - which need regular medical attention. These same illnesses, because of their on-going nature, also place a heavy burden on medical resources. Just in time, a new era of medicine is expanding, known as telehealth or telemedicine. (The two terms are used interchangeably.) Taking advantage of the benefits of all forms of communication, from electronic to digital, it enables patients to communicate with their health care providers without having to go into an office.
In actual fact, telemedicine has been around for some time. Early experiments in this new form of health care delivery used either the telephone or cable TV, but with the sophisticated advances in information technology, new ways are available to expand its reach. Initially, the cable TV operators were skeptical of whether older adults would use an interactive cable channel to talk with a nurse, but when it was tried out at one senior residence everyone in the building joined with enthusiasm.
The Veterans Administration (VA) has been using various forms of telehealth for years. For example, when a veteran with a pacemaker needed to report the data on his implanted device, he could call a dedicated phone number and the date would be automatically be transmitted over the phone. Since then the VA has developed two complementary services for its patients - real-time clinic-based video telehealth (CVT) and home telehealth. To provide care without a veteran, especially those of age, having to travel to a VA facility, the agency has created more than 700 community-based outpatient clinics which can provide diagnoses, manage care, perform check-ups, and “actually provide care,” according to its website, using electronic transmission. Further, the VA acknowledges that “it is now recognized as one of the world leaders in this new area of health care.
Early on in the development of telehealth, there was enough recognition of its potential that the American Telemedicine Association (ATA) was formed in 1993 and Medicare has provided reimbursement for telehealth services since 1997. (For information on its telehealth services see page 55 of the 2018 Medicare handbook.)
But over the past few years this form of medical technology has really taken off.
“Starting Jan. 1, Medicare will begin covering technology-assisted monitoring of patient conditions,” according to an ATA press release. “The new benefit, called Remote Patient Monitoring, will provide Medicare beneficiaries who have one or more chronic conditions the choice to receive in-home monitoring in addition to traditional check-ups in clinics, doctor’s offices and hospitals.”
One survey of telemedicine showed that in 2014, 87 percent of respondents did not expect to see their patients using this form of health care by 2017. This year, however, that number has almost completely turned around with 75 percent of those surveyed saying they are either already using or plan to add telemedicine services.
Respondents were also concerned about reimbursement, although this situation has also improved. Comparing 2014 numbers where 41 percent of respondents received no reimbursement, this year, 76 percent reported being reimbursed.
The survey included hospital executives, specialty clinics, and other health care organizations.
Medicare now offers reimbursement for certain telehealth services, is received from “an eligible provider” who “isn’t at your location.” If a patient lives in a rural area, for instance, the locations where telehealth can be accessed include a doctor’s office, hospital, nursing home or dialysis center.
All beneficiaries who have Medicare Part B are eligible to use these services and the cost is the same as if they were seen by a physician in person.
Some of the services offered include smoking cessation, medication management, home dialysis and psychotherapy.
Legislation has been introduced into the House of Representatives by Congresswoman Diane Black (R-Tenn), the Increasing Telehealth Access to Medicare ( H. R. 3727), which further expands delivery of telehealth services to patients in Medicare Advantage plans and is estimated to save Medicare $45 per visit. “Telehealth focuses on harnessing innovative technology to increase convenience for patients and caregivers, enhance the quality of care and save both patients and the Medicare program money,” said Black, a former nurse. The legislation passed its first step to enactment with unanimous support from the powerful Ways and Means Committee.
Additional legislation introduced by Sen. John McCain (R-Ariz.), the Veterans Community C are and Access Act, includes provisions that would make it easier for physicians to practice telehealth across state lines by overriding licensing restrictions and allow doctors to provide telehealth in other states. One caveat is California, where the state Medical Board has stated that broadening this practice would “undermine California’s ability to protect healthcare consumers.
Significantly, even the American Medical Association (AMA) is getting on board, with a recent issue of its respected publication, the Journal of the American Medical Association (JAMA), suggesting the need for a new medical specialty. As the authors noted critical care only became a distinct area of medicine some 30 years ago, and now might be the time to do the same for telemedicine or as the new terms for this area of medicine is known - “the medical virtualist.” The editorial in JAMA, written by two New York doctors, Michael Nochomovitz and Rahul Sharma, notes that some 70 percent of all patients would be in virtual visits. And, perhaps the strongest argument in favor of telelmedicine, is that it is estimated to create a market worth more than $12 billion by 2020.
It would also mean that these medical virtualists would have to have a broader medical education and, note the authors, a new “webside manner.”
Cheryl M. Keyser is a freelance
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