We don’t have time to protect telemedicine access
The U.S. healthcare system generally develops at an extremely rapid rate, but COVID-19 has pushed it into the future, and telemedicine as a care option has accelerated overnight.
In the first four months of the pandemic, telemedicine accounted for 23.6% In all doctor visits-almost none since a year ago. However, although experts predict that virtual care will continue to exist, the emergency legal provisions that allow it to appear have begun to expire. Now we must figure out how to maintain telemedicine before time runs out.
What we do know is that telemedicine is increasing the interaction between patients and their doctors. As the pandemic eases, in-person visits to the doctor’s office are returning to pre-pandemic norms, and telemedicine is still very powerful. In the Mount Sinai Health System, we will complete an average of more than 42,000 visits per month by 2021, which is many times higher than the annual total before the pandemic.
The huge change in numbers reveals how telemedicine creates new access opportunities for patients. Due to transportation, childcare, work schedules, costs, and other reasons, working families, communities of color, undocumented immigrants, uninsured people, and others have long struggled to receive standard models of care. Remote interaction with doctors can alleviate these challenges and create flexibility for patients so that they can receive care without negotiating logistics — potentially improving health outcomes.
But one obstacle to the growth of telemedicine is that during the pandemic, federal, state, and municipal health officials have taken many measures to expand telemedicine aimed at temporary purposes. If measures that allow telemedicine to flourish eventually fail, the losers will be patients, who begin to rely on telemedicine as a reliable and convenient option for maintaining health.
For example, the medical state-based licensing model has traditionally restricted telemedicine, so it can only be provided in the state where the patient currently lives. But during the pandemic, interstate cooperation agreements allow patients living across the country to receive routine doctor care through telemedicine. If the old licensing system is restored, New Jersey patients may be barred from arranging telemedicine visits with Manhattan doctors—because their doctors may not be licensed in New Jersey.
Health economists may argue that an increase in the total number of healthcare appointments will lead to unnecessary escalations in healthcare usage—increasing overall costs. But there is a way forward to reduce costs.
First, we can focus on granting more telemedicine privileges to health systems that use it as part of their commitment to keep the patient population healthy through preventive measures. In these value-based care arrangements, insurance companies promise to reward hospitals and doctors whose patients continue to stay healthy, rather than those with the heaviest burden (expensive and expensive). May not be necessary) Testing and procedures.
Telemedicine is very suitable for this incentive model. It allows doctors to contact patients on a regular basis, at a lower cost or inconvenience to them or their patients, thereby making the patients healthier. No matter how we meet the care needs of patients, by prioritizing the health of patients, we can help manage the condition of the patient population and improve the quality of life, so that patients can get and maintain healthier.
Another important step is to link telemedicine with innovative delivery methods to connect the community with the care they need. We launched a program in collaboration with community health workers in AIRnyc who provide telemedicine access for physical, behavioral and social care. Patients referred to AIRnyc come from low-income communities and are unlikely to engage in technically supported home care. But through cooperation with community health workers, we have proven that many obstacles can be overcome. Through smart plan design and investment, there are ways to improve care services even without technical skills or access rights.
We should also adjust the permanent implementation of telemedicine to the population health approach. A significant disadvantage of telemedicine is that many disadvantaged patients still have difficulty obtaining the technology and Internet access needed to ensure the reliability of telemedicine. The federal government should use telemedicine as the driving force, and ultimately provide real and sustainable investment in the infrastructure that makes telemedicine possible, starting with universal broadband and WiFi access. The Internet is no longer a commodity, but an important tool to promote health and economic development. We need the federal government to strengthen and guarantee universal WiFi for everyone.
Finally, and most importantly, we need the federal government to work with the State Licensing Commission to permanently expand the privileges established during the pandemic and make telemedicine more flexible.
Permanent placement of telemedicine in our healthcare system can not only improve the health of the community, but it is also more sensible for the overall economics of healthcare provision. The cost of providing care to patients will be lower and the pressure on the health system to provide such care can be reduced. Now is the time to learn every lesson from this pandemic and bring our healthcare system into the future.