Due to the COVID-19 pandemic, many physicians, physician assistants, nurse practitioners, and other health care providers (HCPs) transitioned their clinical practice to telemedicine in the last few weeks. As recommendations from the Centers for Disease Control (CDC) cautioned that older adults, 65 years or older, were at a higher risk for illness with the virus, the Centers for Medicare & Medicaid Services (CMS) “broadened access to telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility.” This was allowed on a temporary and emergency basis through the 1135 waiver authority and Coronavairus Preparedness and Response Supplemental Appropriations Act. Prior to the pandemic, the only Medicare beneficiaries that qualified for telehealth services had to be seen in an originating site in two circumstances: 1) a county outside the Metropolitan Statistical Area (MSA) or 2) a rural Heath Professional Shortage Area (HPSA) in a rural census tract. Examples of originating sites include a physician’s office, hospital, or skilled nursing facility (SNF).
This was a boon to all health care providers because, as we all know, illness does not stop for a pandemic. I work at a heart hospital in Oklahoma City, which employs approximately 90 cardiac and vascular surgeons, interventional cardiologists, electrophysiologists, non-invasive cardiologists, anesthesiologists, and pulmonologists. In addition to serving the greater metropolitan area, we have more than 60 outpatient clinics across the state of Oklahoma, which is largely rural. In the locations where do we not have clinics, it is not unusual for patients to drive 2 to 4 hours for a clinic visit in one of our two city or rural locations. Through all our hospital-based and rural clinics, we serve approximately 100,00 patients.
Oklahoma has 77 counties, of which 76 are designated HPSAs. Even though our practice has extensive outreach, we could ultimately serve more patients with these new telemedicine rules, especially after the pandemic subsides. There are still many challenges posed in telemedicine, including maintaining a patient’s privacy, the security of protected health information, and making appropriate plans of care consistent with an in-person visit. In Oklahoma alone, there will have to be a major expansion of broadband infrastructure to make what I am proposing even feasible. While not all fields of medicine are suited for telehealth and I will continue to see new patients in person to establish a trusting relationship, our own hospital’s telehealth experience with cardiovascular patients has been quite a feat. HCPs across the country have been like the Autobots from the Transformers: we “transformed and rolled out” with telehealth when our patients were being “attacked” by the coronavirus.
The innovations in telemedicine and relaxations of CMS’s policies have created an atmosphere in which health care providers are thriving and doing what we do best: taking care of our patients. Health care providers should implore the Department of Health and Human Services (HHS) and the Trump administration to continue the current CMS telehealth guidelines after the calamity has resolved. They should set an example for commercial insurance companies and lead the way for facilitating patient care. For a large majority of patients, this is the future of medicine, and I foresee this technology becoming mainstream and more widely expected by patients, insurance companies, and used throughout the medical field. This is the new reality in our current dystopian world. And telemedicine is here to stay.
Credit: Subha Varahan is a cardiologist.