Telehealth can help ease the burden
What is telehealth? It’s interacting with a health professional using technology, such as a videoconference. Clinicians can diagnose many medical problems using videoconferencing and—in some cases—can even “listen” through an electronic stethoscope. Of course, a videoconference can never replace a doctor’s complete physical examination, such as touching a distended stomach, when such signs are present.
Telehealth services are not new but have been of limited use because of a number of constraints. Dr. Joe McMenamin, of McMenamin Law Offices, a doctor, and general counsel for the Virginia Telehealth Network, explains the advantages of telehealth and how COVID-19-focused changes to the law have opened this option up to many more people.
At first blush, telehealth may not sound particularly valuable during a pandemic involving a virus that in some respects mimics the SARS virus or other less exotic ailments, but telehealth can still play a major role in easing the burden on the healthcare system during this crisis. For example, McMenamin explains, people with other medical needs, such as a sprained ankle, can use a telehealth solution and accomplish two important goals—keep themselves out of hospitals or other clinical settings, where they could pick up the virus, and lessen the strain on the healthcare system. Of course, sometimes the doctor’s advice might be to be seen in person, but many times an in-person visit is not necessary.
Even for patients who have flu-like symptoms, a video conference may be the best first-line approach. Again, it keeps already sick patients away from a hospital or clinic where infectious diseases can be contracted, while still providing them with a professional opinion about what steps they should be taking. It also keeps contagious patients at home, whenever possible, so they are not spreading microbial pathogens in their search for medical care or testing, McMenamin says. (It must be acknowledged, however, that telehealth by itself does not permit identification of a causative organism. That requires a culture of biologic fluids, and providing samples from a distance is cumbersome. Culture results may be important for identifying patients who do and do not need antimicrobial medicines.)
Distance care can also be a force multiplier, enabling providers to see more patients at a time when the supply of medical professionals lags demand. In certain specialties, the quality of care may actually be better than it is in person. A good example is psychiatry, in which some patients, especially young people, are more comfortable discussing sensitive topics through an electronic medium than in person.
Despite these potential advantages, telehealth usage has been highly restricted largely due to government regulations and third-party payors’ policy restrictions. Generally, the concern has been cost and overuse, McMenamin said. For example, while a videoconference is typically less expensive than an in-person visit, regulators worry that patients who used video chats might still feel the need to visit a doctor’s office or the hospital, effectively being diagnosed twice and adding to costs. Likewise, payors are concerned that arranging a teleconference is usually much easier and more convenient than making a doctor’s appointment, which might encourage overuse. As a result, regulators put significant reimbursement restrictions around telehealth, which in many instances limited its availability to groups with special needs, such as those in rural areas who are unable to transport themselves to medical facilities, which created an obstacle to the expansion of telehealth, McMenamin explained. Likewise, many, though by no means all, private insurance companies have restricted or largely prevented reimbursement of telehealth, as well.
