A long-promised future innovation may finally becoming a reality. No, not the flying cars that we have been told for decades were coming soon, but rather the ability for your doctor to deliver virtual health services—including diagnosis and treatment of medical conditions—through your computer or smartphone. Kaiser Health News reports that “[t]ucked into the federal budget law Congress passed in February was a provision that significantly expands the use of telemedicine — long a hyped health care reform. The new law allows Medicare to cover telemedicine services for people who have had a stroke and those who get kidney dialysis, either at home or at a dialysis facility. It also permits Medicare Advantage Plans — private plans that enroll a third of Medicare beneficiaries — to offer telemedicine as a covered benefit.”
So what exactly is “telemedicine”? The simplest explanation is a patient in one location is examined by a doctor in a different location—a doctor who could be a few blocks away or even thousands of miles away—through the use of computers and a secure video link. These types of doctor-patient consultations are called “e-visits” and, Nebraska Medicine says it can include “[i]nteractive videoconferencing to support specialty services in remote communities, remote patient monitoring (RPM) to support patients as they learn to better manage their chronic diseases and improve their overall health, and video ‘house calls’ with patients at home as they recover from surgery or need additional assistance in their care. Proof that e-visits are joining the mainstream of medicine is evident in the fact that not only do they have Medicare approval, but all private health care plans, the VA and many state Medicaid plans cover some doctor e-visits.
Telemedicine is evolving rapidly and state legislators are under pressure to pass laws that keep up. In 2017 the Nebraska Unicameral enacted a parity law which requires private payers to cover telemedicine services to the same extent that services are covered via in-person care. But, there is no requirement for payment parity. Although most insurers pay the identical rate for e-visits as they do for in-person visits, they are free to reimburse telemedicine consultations at a lower rate. In Iowa a bill approved by the Iowa Senate mandates that health insurers cover both telemedicine and in-person services equally. The Iowa legislature is also examining ways to expand rural access to telemedicine, particularly in specialty areas such as psychiatry. Representative Peter Cownie, (R-Des Moines), points out that “there are a lot of small towns and rural areas where not every hospital has every doctor you might need.”
Kaiser Health News answered three of the most frequently asked questions about telemedicine:
“Q: Do I need special computer equipment?
No. E-visits and other forms of telemedicine are done over commonly available computers, laptops, tablets and smartphones — and are typically encrypted to protect privacy. Specialized equipment is usually needed for remote monitoring, such as blood pressure or heart rate. One vexing barrier: broadband availability in rural areas. Also, millions of low-income and older Americans still lack Wi-Fi in their homes.
Q: What services can I get through telemedicine?
Most e-visits are for primary care or follow-up services, such as assessing symptoms or checking on people who have had a medical procedure. But a growing number — no one keeps national statistics — cater to people with chronic conditions who are being monitored at home. Dermatology e-visits are becoming especially common. You can send a close-up photo of a skin rash, mole or other problem for an immediate assessment. Psychotherapy by e-visit is also expanding.
Q: Are there downsides or risks with telemedicine and e-visits?
There’s no evidence so far that your risk of being diagnosed wrongly or treated inappropriately is any greater with an e-visit compared to an in-person visit.”