The “Devil’s Advocacy” of Yesterday, Government Solution of today- but, one more volatility for Medical Practice of tomorrow
Originally Published by Being Well on Medium
Midst of the spectrum of changes the coronavirus pandemic has brought upon citizens worldwide, be it the direct result of the infection or as part of the reaction to contain the contagion, we can point to the increasing utility of virtual communication. Even within the virtual and Tele-video conferencing modules, one can eyewitness an overwhelming rush to implement some form of Telemedicine or Telehealth systems.
The growth of the Telehealth system has been so fiery that some healthcare administrators have raised concerns about the threat of potential fraud amid COVID-19 pandemonium.
On March 17, after the World Health Organization (WHO) officially declared the Coronavirus pandemic, Medicare administrator (CMS), Seema Verma unveiled an unexpected order to promote virtual medical care or Telehealth clinical encounters. This knee-jerk phenomenon is a shock to those battling reduced restrictions on Telemedicine that the same administration implemented under the bipartisan switch.
The CMS administrator temporarily lifted several federal restrictions on the use of the Telehealth service, which had been primarily limited to rural areas. In her white house briefing in march 2020, She praised Telehealth, announcing it could handle routine care for an older patient with diabetes out of endangering a visit to a medical office.
Under these, Medicare beneficiaries with mild flu-like symptoms could receive advice from a doctor at home. Meanwhile, the Trump administration’s effort also raised concerns that judicious loosening the “chokehold” on Telehealth would potentially unleash a wave of billing frauds and abuse, risking patient safety.
These fraudulent exercises can have harmful outcomes, as virtual rooms operating anywhere in the world can target patient information. At the same time, Medicare resources may struggle to differentiate improper bills from those submitted by genuine Telehealth encounters.
The Telemedicine industry argues their remote systems are no more predisposed to billing violations than any other branch of healthcare. Nevertheless, we all know that chaos and confusion breed fraudulency.
Telehealth of yesterday is no more diverse today, but the attitudes have changed.
Up until the Coronavirus pandemics, there was significant skepticism about the modern Telehealth systems. Some of these concerns to name- according to a survey from web-based Electronic Health Record (EHR) comparison, include:
Lack of in-person interaction, technical issues, inability to perform a physical exam, low quality of care, uncomfortable video, inability to read body language, lack of time spent, and security concerns.
The study finds that security is one of the most emphasized fears patients express among all the fears. Despite the reassurance, it still seems like building voluntary standards or new federal statutes aimed at telehealth systems may not significantly better users’ level of trust.
Addressing patient concerns about the safety and reliability of the telehealth system is essential, without making patients and physicians overconfident about their usefulness by generating false expectations.
Statistics of Telemedicine in 2017
Patient telehealth usage surged between 2005 to 2017. (i.e. From 206 to 202,374) However, While telehealth’s use increased considerably from 2005 to 2017, its utility was still rare by 2017. The growth was mainly attributed to increasing its use by the mental health and radiology domains, which did not require a physical exam routinely.
Telehealth- the notion of Devil’s Advocate
The COVID-19 crisis has exposed the Devil in Telemedicine detail. It has forced medical experts to switch attitudes amid economic concerns by initiating a Model of a can-do attitude.
It has influenced the legislatures to reform the payer requirements and regulatory framework around Telehealth technology. On the other hand, governments were always reluctant to give in to the concept of Telemedicine and virtual clinic encounters, but now they are embracing it like never before.
Coronavirus opened a new door to the radical turnover of Policies
For years the healthcare industry has been striving to implement a telehealth system. However, even though its use became more prevalent, governments were reluctant to provide a complete pass. With the COVID-19 outbreak, there was a radical shift with very little explanation.
The doors have opened for the telehealth technology rush, with all the accompanying unpredictabilities upon its implementation. There will be a flood of products and services and market growth, which is reasonable given the demand for virtual encounters. However, the most significant menace is clearly defining as to what extent can a specific product deliver what is expected.
Browsing through the internet, I stumbled across the following phrase published by American Telemed (ATA)- “TELEHEALTH IS HEALTH.”
The above motto hail from particularly strong but not too astounding!
To a layman’s auricles raising telehealth to the level of health itself, bearing in mind the currently available technologies, is misleading and demonstrates how entities use words and rhetorics to overrate the telehealth system beyond what it is designed to offer.
Telehealth is a valuable technology; hence it can be helpful under definite indications, but making health the same as telehealth is absurd and irresponsible. Another source likewise states:
“When Will Telehealth Simply Be ‘Health’? Some experts say sooner rather than later, although there are roadblocks still in the way, policymakers, providers, and patients are getting more on board with the convenience and benefits that come with virtual healthcare services.”
Together with The American Medical Association (AMA) and their stance on telehealth, medical societies have also been radical by pushing full blasts to promote telehealth.
The Telemedicine enactment shifted into the fast lane over the past couple of months, with virtual healthcare encounters on track to one billion by the end of 2020. According to analysts at Forrester Research, the latter represents a massive increase from telehealth usage before the coronavirus pandemic.
Before the “pandemic,” three obstacles affected the lack of Telehealth adoption, or the slowness of its embracing, ere the “pandemic” kicked. That generally was due to the high cost, low availability, and poor user relationships. Those blocks gave out dramatically after President Donald Trump declared a national state of emergency after the COVID-19 outbreak hit the U.S. The administration actively prompted doctors and patients to “avoid in-person visits” and instead use telehealth visits to help stop the spread of the virus. The latest action by the administration undoubtedly helped overcome one of those barriers mentioned earlier.
According to a study by Frost and Sullivan consultants, the march telehealth visits mounted by 50%. Telemedicine providers such as Teladoc reported a spike in video requests to more than 15,000 per day.
Health insurers and hospitals have delivered a strong push for patients with milder symptoms to use their Telehealth platforms during the crisis to help relieve the strain on emergency rooms and doctors’ offices.
Without a doubt, the Telehealth system plays a constructive role in the COVID-19 pandemic. But, the way it is conveyed is utterly overstatement, especially coming from previously skeptical on Telehealth before the “pandemic.”
The barriers established by the State and federal administrations on Telehealth serve as impediments to the launch of its full aptitudes before the spread of the Coronavirus pandemic.
Before the COVID-19 break, Telehealth and integrated Artificial Intelligence (A.I.) were available. However, they were not commonly implemented in medical practice. But the increasing use of technology has not inevitably been involved in long-standing rules and regulations governing the entire shape of the healthcare practice.
Until lately, telehealth use has primarily remained limited, stifled by the ambiguous and often changing rules on the compensation of doctors and licensure, especially across state lines, given, Telehealth presently plays a critical role in the moderation of COVID-19. Later, On March 6, 2020, Congress enacted the Coronavirus Preparedness and Response Supplemental Appropriations Act. The enactment allows physicians and other healthcare professionals to bill Medicare fee-for-service for patient care delivered by Telehealth during the current coronavirus public health crisis. The bill proffers the U.S. Department of Health and Human Services (HHS) secretary the authority to relinquish or amend specific Telehealth Medicare requirements.
Amid Coronaviirus Pandemics, the Telehealth Market is facing the forthcoming Explosion.
Today Telehealth has become a big business. It is projected that by 2025, its market will exceed $64.1 billion in the U.S., and, Globally, the demand is expected to transcend $130.5 billion.
A Deloitte study in 2018 showed that- almost a quarter of U.S. consumers had had a telehealth visit with a physician. Total numbers of global telehealth patients rose from 0.35 million in 2013 to a projected 7 million in 2018.
Physician adoption has tripled, according to a 2019 survey of 800 physicians. Telehealth is physician-approved, with 90% recognizing that virtual care is advantageous in increased access, communication, and content. Sixty-nine percent of physicians express willingness to use Telehealth in their practice, up from 57% recorded in 2015.
But who is benefiting the most from telehealth technology?
According to a report published by the American Medical Association (AMA), growth in Telehealth is being fueled by ambulatory medical practices, with metropolitan regions outpacing rural countries. On the other hand,- Telehealth tech companies and businesses use the market demand to disseminate the remote visit. In the process, they are judiciously using the slogan “Telehealth is Health.”
Based on the feedback reported in The Journal of Electronic Health Data and Methods at Concordium 2016, there is an overwhelming need to help instruct policymakers, payers, and health systems about the value of Telehealth. There is a need to frame a spectrum of conversations around implementation barriers, including risk management matters, technology expenses, and organizational habits. However, enigmas continue around propagating and using the telehealth system structure to help coordinate policy, research, and implementation trials in the delivery system.
It seems, however, that the market expansion pace around Telehealth is much more speedy than one can build the framework.
Coronavirus pandemic is facing a Solution with Attitude.
Although the most significant barriers to Telehealth were the governments, payers, and HIPAA, patient privacy restrictions came decaying down amid the COVID-19 pandemic. Older patients and technology Barriers to Telehealth are correspondingly prevalent partially due to the lack of technology or knowledge to operate. A Kaiser Family Foundation survey saw that only 7 in 10 adults 65 and older report having a computer, smartphone, or tablet with Internet access. But they worry more about privacy. There may still be reluctance among older individuals to have these communications.
Lack of infrastructure and broadband access are among the other reasons some smaller clinics do not have the foundation or exercise to swivel to an online business model when the pandemic hits.
Avoiding misconception- or the Slippery Slope
Effect of Telehealth on small medical practices
Physicians now have overwhelming pressure to consider alternate shared services delivery models that telemedicine solutions can offer. Using telemedicine platforms, physicians need to contemplate beyond the casual influence of recent telemedicine developments. They need to consider how much the Telehealth systems will improve patient health outcomes and resolve business requirements. While they are considering the latter, physicians also need to understand the concept of corporate expansion, which is threatening their autonomy.
Telemedicine, notwithstanding that it is not a new technology anymore, remains a buzzword across the healthcare and non-healthcare industry. Telemedicine extends opportunities for significant gains and various reasons, yet not all are centered around the doctor-patient encounter.
Controversially, some believe Telemedicine renders outcomes are equivalent to regular in-person visits.
A recent analytics survey performed by the Healthcare Information and Management Systems Society reports that 55% of hospital respondents were not convinced they would buy in Telemedicine. A 2017 Medical Economics survey showed smaller practices using the telehealth system are less than 20%. Since that study, Telehealth technology has had little or no change or improvement, but more and more patients and physicians have been convinced to use them today. Again, the Latter is not necessarily because physicians and patients have received better technology, but merely because of the Coronavirus crisis and fear of being exposed to the infectious agent and losing business.
Today patients and physicians are starting to trust that Telemedicine is a lifesaving tool and is equal to or even better than an actual office visit. They are also made to believe that telehealth liability is not substantially higher than the actual appointment. While at it, physicians also need to think and function as a prominent organization if they intend to be competitive and survive. For example, physicians need to contemplate medical liability when adding telemedicine services. A practice’s malpractice insurance plan may require switching to cover remote care delivery.
Product liability is a big concern because medical care can and will grieve if the technology isn’t trustworthy. Telemedicine compensations can vary significantly from insurer to payer, as it is unsurprisingly riddled with concealed deceits and monopoly.
Telemedicine clasps many potentials to aid medical practices promote efficiency, cut costs, and increase patient satisfaction. Still, consumer expectations will drive even the most minor providers to find ways to affiliate with organizations that can help them implement at least some Telemedicine opportunities. With the technology continuing to expand across the globe, patients will increasingly expect access via Telemedicine. But- Telehealth also carries the risk of corporate medicine. The substance is that a spectrum of vagueness exists, as every client makes a business judgment about how aggressive they want to be in pushing the limits. The Corporate Practice of Medicine concept continues to confuse, beleaguer, and puzzle healthcare companies are experimenting with physicians and non-physician entrepreneurs. Unlicensed & Corporate Practice of Medicine is waning to direct and monitor personnel and independent contractors concerning the declarations, claims, and promises to the healthcare organization’s patrons.
While the Telehealth industry is developing with the speed of light, there are nevertheless challenges to acknowledge. Although a good concept, they incorporate new technologies and means to medical practice; it is a big move and shouldn’t be taken indiscriminately.
While Telemedicine cheers an overgrowth in years to come with explicit privileges, it still poses some technical and practical problems for physicians and predominantly small medical practices.
Reduced Medical Care Continuity
It is the innate human trait- when as patients, they are using “on-demand” Telehealth systems that are, in turn, able to connect them with a random medical professional; medical care will parallelly suffer. Of course, the latter is easily preventable. Nonetheless, the procedure can go either way, contingent on conveying the message to the patients and physicians. For instance, if a patient or physician is under the impression that Telehealth, as it currently stands, can replace actual In-person visits, then indeed we are setting ourselves loose in the path of failure. Under a centralized yet fragmented health record system, a patient’s family doctor may not have access to records from those other (On-demand) visits and end up with an incomplete history for the patient. In contrast, the patient has easy access to every clinic. Service provider scuffling heightens the risk that a doctor won’t know a patient’s history or have notes about care routines, which is even more vital given the limited capability to do proper physical exams using most current technologies.
Reduced care continuity can independently reduce the quality of medical care; hence Telehealth must also incorporate sound data solutions to maintain adequate and accessible patient records, interoperable and secure.
Technical Training and Equipment
Training is fundamental to building an effective Telehealth system. Physicians, practice managers, and other medical staff need to be trained on the new methods to warrant a solid return on investment. Restructuring Information Technology staff obligations and purchasing equipment takes time and is expensive.
Fewer In-Person Consultations
“Personal touch” is always vital for patient care. However, in situations where patients can’t get in to see their doctors in person, and for many cases that don’t require a physical exam, Telehealth can be a good alternative. But then again, this is a slippery slope, as people, including patients and physicians, are the creature of habits. They tend to tumble into the deception of Telehealth only practice- surly and conveniently. one must prevent the latter at all costs. It will be very conceivable that the tech industry will publicize to exploit their profit in any way they can, primarily employing the COVID-19 pandemic state of affairs, but we must stop it. Oversized systems will hardly fall into the “Telehealth Default Practice” trap as many alert systems are in place. Still, Independent medical practices are the most vulnerable of all to fall into the trap of the alleged scheme.
Hidden Policies and Reimbursement Practices of Telehealth Practice
Healthcare legislation, payment policies, and privacy security rules strive to keep up with this fast-growing industry. While significant improvements have been made to Telehealth reimbursement over the past years, many uncertainties remain. It may have many regulatory strings attached to it, and many privacy jeopardized if not correctly implemented.
Telehealth is a wealthy industry. While it still has some limitations, physicians must become innovative in using them.
Telehealth of the Tomorrow
The global telehealth demand will touch $ 55.6 billion by 2025 from $ 25.4 billion in 2020. This market growth is merely driven by determinants such as the rising population, the need to expand healthcare entrance, the spreading pervasiveness of chronic diseases and conditions, a shortage of physicians, developments in telecommunications, and government backing and growing awareness.
Despite all the pros and Cons of Telehealth as well as its unpredictabilities- Today, we can see prominent players, or Disruptors, in the Telehealth market, few to name, according to the Markets and Market:
“The major players in the global telehealth market are Koninklijke Philips N.V. (Netherlands), Medtronic (Ireland), G.E. Healthcare (U.S.). Other prominent players in this market include Cerner Corporation (U.S.), Siemens Healthineers (Germany), Cisco Systems, Inc. (U.S.), Teladoc Health Inc. (U.S.), American Well (U.S.), AMC Health (U.S.), MDLive (U.S.), Doctor on Demand (U.S.), Medvivo Group Ltd (U.K.), Asahi Kasie Corporation (Japan), Iron Bow Technologies (U.S.), Telespecialists Llc (U.S.), GlobalMed (U.S.), MedWeb (U.S.), IMediplus Inc. (China), Vsee (U.S.), Chiron Health (U.S.), Zipnosis (U.S.).”
By application, the Teleradiology segment of the Telehealth system is estimated for the largest market share in 2019. The Telehealth market is also segmented into various subcategories. These include Teleradiology, Tele-ICU, Telestroke, Teleconsultation, Telepsychiatry, Teledermatology, and other applications.
By end-user, the physician sector witnesses the highest growth during the conjecture period.
The worldwide telehealth market is sketchily segmented into physicians, payers, patients, and other end-users based on end-users. The physician’s sector accounted for the prime share of the global telehealth market in 2019.
On the other hand, in the United States bipartisan group of 30 senators recently urged congressional leaders to make permanent provisions included in previous COVID-19 legislation to expand access to telehealth services for Medicare recipients.
Let us remember remote is remote, onsite is onsite
Let us not be distracted by the titles Such as “When Will Telehealth Simply Be ‘Health’? Some Experts Say Sooner Rather Than Later,” which are not only misleading but also dangerous to patients, Physicians, and humanity.
Telehealth is, undeniably, a vibrant technology for the betterment of medical service delivery. And until it proves to us that it will replace human touch, we must be aware of the untruthful rhetorics.
So let us talk the talk and then Walk the walk.
Meanwhile, physicians must take ownership of their domain in the Telehealth industry and guide the development of a system that is one hundred percent within the perimeters of their ethical and Hippocratic oath.
Help us use technology without profiteering intents, which are patient-centered and respect their sovereignty and privacy. Indeed, amid the Coronavirus crisis, we see a progressive front of Devil’s Advocacy played by 3rd party alternate group, testing the determination of physicians and the healthcare community biting the wrong bait by creating the opposing arguments. That is why the healthcare community, independent physicians, in particular, need to show extra vigilance.