CMS needs to permanently eliminate barriers preventing routine use of telemedicine

On March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) provided a temporary waiver to expand telemedicine services, whose use was previously limited to specific circumstances. However, as the United States grapples with the unprecedented impact of the COVID-19 pandemic on our nation’s health care system, CMS should permanently eliminate barriers limiting the routine use of telemedicine.

As clinicians, we can only guess at the rate of transmission of coronavirus in the United States, but many of our nation’s rural and urban health care systems struggle to provide care to those already in crisis.  Many communities may be weeks from seeing infections peak. Telemedicine is a vital component of our strategy for providing care while limiting the spread of this virus.

Before this public health emergency, available technology was already becoming increasingly sophisticated in our homes and within our health care systems.  Yet, major barriers prevented wide-spread adoption of telemedicine, with poor reimbursement frequently cited as one of the main causes.

As a geriatrician working in a large urban academic center, I see firsthand the struggles and frustrations of my frail, vulnerable patients: logistical difficulties setting up in-person medical appointments, difficulty leaving their homes, and navigating transportation issues while coping with increasing disability and decreased function. I also hear from frustrated caregivers, attempting to balance job obligations with providing essential care, coordination, and oversight for a loved one. Frequently, caregivers lose time at work to attend an older relative’s medical appointments – and, as many of us know too well, there can be many. An absentee caregiver also presents challenges for clinicians.  We often devote significant time after the visit has concluded to provide a family member with counseling, education, and further coordination of care.

Now, more than ever, it is important to limit nonessential contact between patients and clinicians to prevent the spread of the coronavirus. As clinicians, we shouldn’t look at public health emergencies as opportunities, yet COVID-19 presents one.

For the first time, clinicians are witnessing significant changes to Medicare rules, regulations, and reimbursement rates that prioritize patient access and care via telemedicine.  Telehealth is no longer limited to demonstration projects, or rural patients, or specially funded clinics. Primary care physicians (PCPs) and specialists are now able to use telemedicine to provide an integral continuum of care and access. Telemedicine has proven to be an essential tool nationally, be it in urban, suburban, or rural communities. It ensures patients receive timely and appropriate care. Following CMS’s loosening of telemedicine restrictions, we witnessed immediate, widespread adoption of telemedicine. At-risk, vulnerable patients now remain safely at home and away from the nation’s emergency rooms.  Social distancing and telemedicine are directly responsible for keeping non-critical patients from overburdening already strained emergency rooms and inpatient units, allowing hospitals and PCPs to devote limited resources to the care of patients in crisis.

Before coronavirus and COVID-19 became household terms, clinicians advocated for CMS to lift its strict rules regulations limiting telemedicine. Admittedly, telemedicine has its limitations.  It is not a panacea.  However, for well-established patients, their caregivers, and increasingly resource-strapped clinicians, telemedicine can be a lifeline. It maintains a patient’s relationships with PCPs, improves care coordination and management of chronic medical conditions, and facilitates goals of care discussions.

In the last three weeks, my clinic transitioned from 100 percent face-to-face encounters to strictly telephone check-ups and video visits. Our patients and caregivers report they are grateful not to experience disruptions in their care as we continue to keep follow up appointments and, if they feel comfortable, address new concerns from the safety of their homes via telehealth. Our self- quarantined patients depend on the clinic’s physicians to be trusted voice, providing guidance, counseling, comfort, and knowledge.

As clinicians, my colleagues and I pride ourselves on practicing evidence-based medicine. Yet, medical literature reports that, on average, there is a 17-year delay between when initial evidence shows positive patient outcomes and wide-spread adoption of that treatment or practice. Policy interventions can help decrease these barriers. Prior to this pandemic, the record was already replete with evidence demonstrating that telemedicine improves patient outcomes and results in higher satisfaction of care and cost savings.

Whether the patient lives in a rural, suburban, or urban setting, they face similar challenges. And so do we, as their physicians. Increasingly, we navigate a complex health care system filled with greater administrative burdens. This takes time away from our patients and decreases patient satisfaction with their level of care as we split focus between assessing the patient and managing paperwork. All this limits the joy and satisfaction clinicians find in their work, contributing to burnout. Importantly, and not just during a pandemic, telemedicine can help alleviate stressors on the patient, the caregiver, and the physician.

While preparing to assist our patients in the emergency rooms and dedicated COVID-19 wards, our clinic continues to triage patient concerns, creates new care plans, and provides a necessary layer of support, reassurance, and education in a chaotic and stressful time. Like all of you, my colleagues and I look forward to resuming our normal lives as once this pandemic is resolved. But, the resolution of this unprecedented public health emergency should not be a reason for CMS to revert back to its old rules. As these first weeks have shown, telemedicine is a valuable, proven, and effective tool for our patients, their families, and our medical community.

Magdalena Bednarczyk is a geriatric medicine physician.

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