What’s Working and What Isn’t in Telemedicine
Half of all healthcare professionals (https://www.fiercehealthcare.com/practices/half-physicians-now-using-telehealth-as-covid-changes-practice-operations) have started using telemedicine in response to the COVID-19 coronavirus pandemic. Patients and providers are trying to adjust to such rapid changes in the provision of health care. Providers want to know how to get reimbursement for telemedicine visits. Society is working together to answer the critical questions about this next wave of health care.
Patients Respond to Telemedicine
My institution’s introduction to telemedicine was through phone call visits with patients when COVID-19 first began. When patients came to infusion after a telemedicine visit, they reported mixed responses. Some were so afraid of exposure that that they loved (https://www.healthcareitnews.com/news/survey-americans-perceptions-telehealth-covid-19-era) the idea of converting both chemotherapy teaching and provider visits to telemedicine visits. This subset seems to be adjusting to the new norm very well. They are organized, write down questions they need to ask their healthcare provider, and have a journal of side effects from their treatment. These patients come in all shapes, sizes, forms, and various age groups.
However, there is another subset of patients who still prefer face-to-face consultations (https://mhealthintelligence.com/news/consumers-like-telehealth-but-still-prefer-face-to-face-healthcare). They value the in-person time they get with their healthcare provider. Many have told me that they can’t think of questions or forget to mention their side effects over the phone or on a video call with a provider, although they seem to remember exactly what to ask and talk about when they see that same provider in-person. And some older patients don’t know how to start a video visit or don’t have the resources to do so.
One solution is offering an over-the-phone consultation for patients who don’t have computer access or can’t figure out how to set up video conferencing on their computers. However, many patients are skeptical (https://www.healthcareitnews.com/news/survey-americans-perceptions-telehealth-covid-19-era) about using telemedicine moving forward. Don’t get me wrong, these patients are still afraid of the risk of exposure to COVID-19. However, they seem to find more benefit in seeing their healthcare provider in person.
How to Navigate Care in a Digital World
The same goes for nurses. The millennial generation of nurses seems to be flawless and fluent in conducting assessments and chemotherapy education over the phone or computer, whereas nurses from older generations are finding a few more challenges (https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No2-May-2016/Multigenerational-Challenges.html).
Does this mean that they will never adapt to technology and be comfortable with it? I don’t think so. But it will take some time for these nurses to become fluent in telemedicine, and we need to acknowledge this gap in the healthcare workforce.
The Cost of Telemedicine
On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) expanded the range (https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet) of reimbursable services patients receive from healthcare providers so that they don’t have to travel to a healthcare facility. However, every insurance company seems to require different (https://www.medpagetoday.com/infectiousdisease/covid19/85990) billing codes and modifiers to submit for these visits.
Electronic health record systems such as EPIC are critical to document telemedicine visits for reimbursement. Now we are trying to convert more of our visits to video calls so that a provider can see the patient remotely and conduct a more thorough assessment than what’s possible with a phone call alone.
All of this makes me wonder—and a lot of patients too—if this world of televisits and telemedicine is our new normal. But what about the patient population who does not have access to technology, who has cognitive deficits, or who has other barriers to using telehealth? For these and many other reasons, I think that, for the amount of oncology providers and patients who love telemedicine, just as many don’t.
I would love to know what you and your institution are doing to get patients and providers more comfortable with telemedicine. Please email your comments and thoughts to firstname.lastname@example.org (mailto:email@example.com)