Originally published by Technology Hits on Medium
Before the COVID-19 pandemic, the concept of the remote patient encounter was a matter of a business decision. Major insurance companies, including those of the government-run programs, were very stringent about appropriating telehealth reimbursement. Before the pandemic, regulations were more rigid, and the medical community was very stagnant in accommodating a remote patient visit to their practices unless there would be a clear financial incentive.
Now, one year after the Coronavirus pandemic and billions of dollars of economic setback, healthcare administrations around the world are ironically promoting Remote patient encounters. It seems like a Déjà vu or history is repeating itself. In other words, Telehealth would stay a controversial issue if it wasn’t for the pandemic. But to the irony, again, the momentum that the administrations are moving Telehealth to the market opens another argument. That is when Telehealth will fund its legitimate position in the healthcare market, how and at what expense to the patients and medical community.
Indeed, at some point, from the controversial issues about a decade ago to full-fledged telemedicine today, we need to find that comfort zone accommodating the proper telehealth practice in the medical arena.
Telehealth brings new benefits to Healthcare
Telehealth points to the utility of digital information and communication technologies so that the medical communities can provide healthcare services from remote locations.
The customary rhetorical around Telehealth is around making medical services accessible to people who live in rural or deserted neighborhoods, making services more readily available or convenient for people with limited mobility, time, or transportation options. Telehealth is also devised to provide access to medical specialists, improve communication and coordination of care and bolster self-medical care.
Telehealth facilitates public health alleviation methods by increasing social distancing. It cuts the load on the healthcare system by dampening the surge of patient demand on facilities and diminishing resources. It helps maintain continuity of care. Remote admission using Telehealth can also enable preserving the patient-doctor relationship when an in-person visit is not practical. Telehealth services are cast-off to screen patients who may have symptoms of COVID-19 and refer as appropriate, provide low-risk urgent care for non-COVID-19 conditions, identify those persons who may need additional medical consultation or assessment. Access to medical services and specialists, including mental and behavioral health, for chronic health conditions and medication management, is further encouraged by Telehealth and provides coaching guidance and support for patients with chronic health conditions. Telehealth accommodates patient engagement in case of management for patients who have difficulty accessing care.
Using remote Telehealth, encounter medical professionals provide education and training through peer-to-peer professional medical consultation.
Telehealth as a business model is veering the paradigm by expanding consumer-based care. It facilitates clinical workflow, serves as the line for faster prioritization of care delivery. It Increases practice revenue, cuts overhead, and reduces costs.
In addition to benefits, Telehealth also brings new challenges
Implementing telemedicine has always faced its challenges. But today, such intricacies have multiplied. Post-pandemic implications of Telehealth have added pieces to the already existing puzzles, including but not limited to regulatory and privacy issues. When we are still struggling to maintain individual information sovereignty, more and more industries (most being non-medical) are trying to tap into telehealth data and information.
The number of telehealth regulatory shifts has occurred in reaction to COVID-19 — some of the resources and challenges inherent in successfully harnessing the unexpected expanded role recently given to Telehealth.
Recently the need to incentivize Telehealth, some private payers and Medicaid programs declared payment equality for Telehealth for the duration of the pandemic. That was one of the most significant moves related to the COVID-19 pandemic when payment parity between Telehealth and in-clinic care was previously lacking. Low reimbursement for Telehealth was viewed as a critical disincentive. So, it would be impossible for clinicians to afford to furnish the remote medical service without compensation. Today, the concept of pay equity is arising to avoid perversely incentivizing the use of telehealth encounters.
With particular stress on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patient privacy regulations are anticipated to be a likely obstacle to the broader adoption of Telehealth. Indeed, it is a complex task for the average physician to sign a business agreement with a telehealth company that will genuinely ensure patient information security and proactively prevent its abuse. But, in reaction to the pandemic, the Office for Civil Rights at the Department of Health and Human Services issued a report waving the sanction imposition enforcement for HIPAA violations that occur during in good faith Telehealth delivery during the COVID-19 emergency. That authorizes clinicians and healthcare entities to wield platforms that are not HIPAA compliant, such as Facetime and other commonly used channels, a controversial move that can carry many backlashes in years to come. That includes continuous and lifetime access to vital patient information by non-medical entities.
It is important to remember that Telehealth will never replace actual in-person clinic visits. It was fundamentally mistaken to “shut down private clinics only to save people from the pandemic.” Preserving independent medical practices is fundamental in any scenario, Specially during a pandemic. Current rulings are the replica of the Dust Bowl Phenomenon.
Telehealth, just like any other subject or opportunity, is subjected to limitations and monopoly. It, too, follows the preordained geographic rules that govern medical licensing. Previously, some states in the united states, such as Ohio, New Mexico, and Texas, have formed special telehealth authorizations. Other states, such as Tennessee, Arizona, and Vermont, too, entered into the Interstate Medical Licensing treaty to allow out-of-state physicians to practice in their dominions via Telehealth. Although such laws establish a slacker environment, additional mechanisms are bringing thought to curb telehealth practice and increase oversight on physicians. That is just another trojan horse in the modern understanding, further jeopardizing individual liberty. For instance, recorded calls could be used to audit and monitor the insurance and finance industries’ provisions with an excuse to guarantee patient privacy and confidentiality. But such monitoring and audit processes do not seem to have well-defined privacy and rational data safeguarding.
Telehealth opens the door to new avenues, thus closing another
Telehealth is opening many doors, but not all of those are exclusive to patients’ welfare.
The COVID-19 coronavirus pandemic has changed the mode of interaction between people. Such an embrace of remote-video technology has broadened clinical interactions. It has brought about some changes that may be permanent, from the way healthcare is utilized to the government’s reimbursement policies.
Even clinicians who formerly didn’t offer telehealth services remain scrambling to implement the technology in some form. That is equally a way to maintain patient-care standards and as a means of making up for revenue lost through avenues such as elective surgeries, which have been placed on hold during the pandemic. Telehealth is rumbling in vogue. In comparison, this care delivery model was never intended to have an equal footing with in-person clinical encounters. This response to patients’ demands will potentially spur regulatory interactions that will change how independent physicians will practice but not necessarily in a positive direction: more regulation, more burden, and more frustration.
As Telehealth is crossing geographic boundaries, so are the legal breaches amidst healthcare socioeconomic globalization. Restrictions are being loosened for physicians delivering medical care across geopolitical lines with the intent to provide care to those in need. Two facets of telemedicine practice can potentially lead to an increased prospect of crossing the borderline, thus detrimental desecrations. The flexibility of service distribution can potentially have frequent and casual interactions and behaviors. The assumption that protects and makes the relationship immune to boundary crossings and violations is faulty.
Advancing Telehealth is currently shaping international law and so ensures the way physicians will practice in the future. However, it will probably do that in terms of globalist terms.
On paper, Telehealth is the faultless answer to save costs, ensuring better access to healthcare for all. However, New findings by the Center for Medicare Services (CMS) reveal the relatively low adoption rate of Telehealth services which can provide value-based amenities without growing the cost.
If it were not because of the coronavirus pandemic and governments released slack to the tech industries, we would still be struggling to implement telehealth systems in medical practices. That means it would only take economic incentives to promote telehealth platforms.
Telehealth is a significant contributor to value-based care and will be a valuable instrument for resourceful care delivery for years. However, we need to keep in mind in addition account for the tests that come with any technology-based treatment such as Telehealth.
The new avenues reset boundaries at what cost and by whom?
The technology used in medicine has advanced by leaps and bounds in technology. Still, One of the main reasons is the gap between healthcare professionals and the technology manufacturer. We must agree; Telehealth comes with limited utilities and often insufficient utility validation.
Regarding proper validation of the appropriate utility of Telehealth, it is not a hidden fact that almost all innovations are motivated by the interests of angel investors, venture capital, private equity, entrepreneurs, or a combination of all.
The very nature of the business model makes the end products or deliverables vulnerable to premature rollout and bias.
Medicare allows Telehealth services for opioid rehabilitation, psychiatry, and rural areas. Psychiatry is the most common field for adopting Telehealth services, and 85.4% of people using it had a mental health diagnosis. Their use is valid as current systems cannot be used or are validated only for specific cases.
Inventions of the Telehealth system have been marketed to businesses and customers to replace direct onsite clinical visits. That fuels a misunderstanding but can have significantly treacherous upshots for physicians as well as the patients.
Telehealth services at their current standing can never be a general auxiliary to clinical visits, required in many cases. Upholding the telehealth applicability encourages managed care organizations to keep patients at home, reducing clinical or hospital visits. It makes perfect sense to maximize public health benefits and reduce costs by cutting down the number of hospital or clinic visits. But there is a delicate line flanked by keeping patients at home by entirely offering virtual care, thus confining patients at home; their medical glitches can be achieved over Telehealth.
The utility of the Telehealth scheme will set new parameters on the standard of care, making the resources available to everyone. However, the availability of resources will be limited by the technology landscape of the given Telehealth system. But what is unclear today is that we will see the line is drawn, by whom and whose terms.