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It’s Time to Permanently Expand Telemedicine
Telemedicine has helped millions during COVID-19, and its expansion needs to stay after the pandemic is over.
THE COVID-19 PANDEMIC is nothing my medical school training could ever have prepared me for. As a neurologist, I have witnessed strains on my patients, colleagues and the medical institution where I work up close. In my headache medicine practice, I have started to see a rising number of people with cases or suspected cases of COVID-19 complaining of new or worsening headaches.
Fortunately, because of federal and state changes allowing for expanded coverage of telemedicine and because private insurers have followed along, I have been able to see these patients safely and without risk of exposure. Before the pandemic, telemedicine coverage by neurologists was largely limited, often restricted to rural communities and cases of stroke care. Just a few months before the pandemic, I hesitated to adopt telemedicine because I felt it would not be an equivalent experience to an in-person patient encounter.
Now, I'm convinced telemedicine is a valuable option that needs to stay.
Here's why: Patients – some who live too far to travel for care and in neighborhoods with too few specialists – now have access to that care. Many of my patients suffer from chronic migraine, defined as having at least 15 headache days per month for more than three months, with roughly half of those headaches each month being severe. Migraine attacks are so extreme that they can make someone bedbound; routine physical exertion can be debilitating.
Given all this, it's not a surprise that so many patients prefer a virtual option. Even everyday sounds and light at a busy clinic can worsen migraine attacks. Importantly, recent research has shown that the quality of telemedicine headache care is not inferior to in-person visits and meets similar standards of patient satisfaction. One study showed that for patients with severe migraine-related disability, telemedicine was feasible and an effective alternative to in-person visits for follow-up care. Even among pediatric patients and their families, telemedicine was perceived as cost-effective and caused less disruption in daily routines.
Another condition known as medication overuse headache is common and can be associated with opiate overuse, depression and sleep disorders. It can be difficult to treat; however, a controlled trial provided evidence that video consultations can be a good alternative. Many patients also have other chronic conditions such as chronic back and neck disorders or generalized arthritis, making long travel times to see a doctor very difficult.
To be fair, there are several problems that still must be addressed before telemedicine can be permanently and successfully a part of how we deliver health care. For one, telemedicine is currently limited by the quality of current software and broadband connectivity, so there will need to be collaborative efforts between telecommunication companies and state and federal agencies to fill gaps for more reliable connectivity. A lack of technology skills, privacy concerns and overall mistrust also are critical patient barriers. However, solutions such as having staff help patients work through connectivity and other technical issues during pre-visits can improve the process.
From a health systems perspective, a lack of integration with electronic medical records and the cost of the technology may be burdensome for some medical institutions and private practices. Different policies in each state may be a barrier for multistate providers, and may vary regarding insurance coverage for services provided by video or telephone. Not every state has payment parity with in-person visits, and issues of reimbursement remain concerning.
Yet our country must rise to the occasion and improve access to care by making telemedicine permanent. With more than 5 million COVID-19-infected individuals and over 160,000 deaths in the U.S. alone, this disease will not be going away anytime soon. But even after the pandemic, we're likely to see a prolonged economic recovery period, and patients – many of whom may have exhausted their sick time – would no longer have to choose between missing work and going to the doctor's office because of the ease of telemedicine.
To date, I have seen many essential workers – including teachers, police officers and nurses – and often, people who need to be home for child care. The burden of lost work time may disproportionately affect African Americans, Hispanics and those of a low socioeconomic status, who are already more likely to suffer from persistent health inequities and have been hit particularly hard by the coronavirus.
Virtual health care services are predicted to reach 1 billion encounters by the end of the year. Meanwhile, the costs and the time that go into adapting telemedicine for clinical services are an enormous investment. Legislation that aims to mandate telemedicine permanently, like the Helping Ensure Access to Local TeleHealth Act of 2020, could make all the difference for chronic disease management and future pandemics.
Permanent private and Medicare coverage for telehealth services that remove location requirements could help facilitate widespread adoption, especially for communities in need. As we look to the future after COVID-19, we cannot go back to old systems of care that do not work for everyone.
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