Page 14 - Spring 2021

Practice of Medicine
Telemedicine – Here to stay... but what flavor will it be?
Michael Cromer, MD drmcromer@gmail.com
One thing that the COVID pan- demic did was fuel the rapid growth of telemedicine visits. At the peak of the summer 2020, telemedicine visit numbers had grown >400% compared to the same period the year before. Things have calmed down a little from May when televisits comprised 69% of all claims to November when they comprised 21% of all claims.
One thing for certain is that tele- medicine is here to stay. . . and for good reason. It provides people, who because of personal circumstances or due to lack of access, an ability to get quality medical care when they oth- erwise would not have received it. It has been shown to save in healthcare costs and it certainly provides an avenue for medical care when a patient would not be able to travel for an in-person
visit.
Another reason for the rapid growth was due to the paucity of telemedicine visits prior to the pandemic starting. The lack of telemedicine visits was for good reason, there were many re- strictions placed by the federal and state government on tele- health visits (too many to name). One of these restrictions was that patients would not be able to use their own computer if it could not download a HIPAA compliant platform for telemedi- cine visits. Also, physicians were paid very little or sometimes not at all for telemedicine visits.
In March of 2020, Governor DeSantis instituted an emergen- cy order for the use of telemedicine and many of the restrictions were lifted and physicians started getting paid on par with the equivalent in-person visits.
When things get back more toward normal and patients feel more comfortable traveling to physicians’ offices, the percent- age of telemedicine visits no doubt will decline a little but there still will be a need for it. The greatest needs are among cer- tain populations of patients (homebound, rural areas, younger generations). The emergency order will one day be lifted but I would like to share with you some of the issues that I feel will be important for the telemedicine world to remain viable and useful.
Payment parity – Insurance companies certainly will be lob- bying against this. Our overhead remains the same whether we see patients in person or on the computer. Risk remains the same. Our skill set and knowledge pool remains the same. There will be some who will want to make it a contractual issue (“free market”), but not all physicians will have equal bargain- ing positions.
Allow telephonic visits to get paid on parity, especially with Behavioral Health. This is currently prohibited even with the emergency order.
Prescribing of controlled substances. The emergency order has allowed follow up visits to be done through telemedicine visits. Prior to the order, prescribing controlled substances vis telemedicine was limited to nursing homes, Hospice, and psych patients. I feel that after the emergency order expires all con- trolled substances should be allowed to be prescribed, especially for stable, established patients.
Supervisory – Clarification will need to be made on how close and what type of supervision will need to exist for Ad- vanced Practice Clinicians.
HIPAA compliant rules need to be relaxed. If a platform like Zoom or Skype cannot guarantee HIPAA compliance, I feel that as long as a statement of precaution to the patient is given, the patient can choose whether to have a visit on that type of for- mat.
These are some of the issues that are going to be addressed legislatively this year, both on the federal and the state level. HCMA’s Government Affairs Committee has been at work al- ready this year, educating our Legislators on this topic, so that as bills come through committees, we will have let them know our concerns.
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HCMA BULLETIN, Vol 66, No. 4 – Spring 2021