Conflicting government regulations for practitioners and practitioners must be reconciled for telemedicine to reach its potential. „State and federal barriers to the use of telemedicine and AI have hindered the adoption of their full capabilities.” In addition to these findings, several bills have been introduced in Congress to improve the reach of telemedicine in Medicare. In December 2015, the bipartisan Telehealth Innovation and Improvement Act was first introduced in the House of Representatives by Representatives Diane Black (R-Tennessee) and Scott H. Peters (D-California),22 then in the Senate by Senators Gary Peters (D-Michigan) and Cory Gardner (R-Colorado).23 The bills are identical and address the lack of Medicare coverage for telehealth services, which senators say sets a poor industry standard, discourages innovation, and limits access to specialized services.24 The bills require HHS`s Center for Medicare and Medicaid Innovation (CMMI): Allow eligible hospitals to test telehealth services. CMMI must also independently review and evaluate telemedicine models to determine cost, effectiveness and improvement in quality of care without increasing delivery costs. If these criteria are met, the model will be covered by the broader Medicare program. The bills have been referred to various House and Senate committees for review.22,23 Prior to the coronavirus outbreak, telemedicine and embedded AI were somewhat familiar, though uncommon in practice. However, the increasing use of technology has not necessarily been taken into account by long-standing rules and regulations that apply to the entire health system. Until recently, the use of telemedicine was largely restricted, stifled by ambiguous and often changing regulations on reimbursement and licensing of physicians, especially between states. State and federal barriers to the use of telemedicine and AI have hindered the adoption of their full capabilities, especially laws that are a patchwork of accepted and ineligible costs and services. Given that telemedicine is now playing a critical role in bringing COVID-19 under control, how guided will the U.S. be by its rapid adoption and use? Specifically, how can telemedicine be more visibly positioned as an important aspect of healthcare in a post-COVID-19 healthcare ecosystem? And will telemedicine practices continue without the restrictions previously enforced by state and federal laws, particularly with respect to reimbursement of services or parity agreements? This perspective describes some of the key regulatory changes in the field of telemedicine that have occurred in response to COVID-19 and discusses some of the opportunities and challenges associated with successfully exploiting the unexpected expanded role recently assigned to telemedicine in the United States. To ensure that the increased use of telemedicine observed during the COVID-19 pandemic is not wasted, the lessons of this period of deregulation must be carefully learned.
Some changes, such as the elimination of parts of HIPAA, are clearly intended for a crisis, but may suggest areas where lasting regulatory changes could be beneficial. Other changes, such as fair payments instead of parity, should be considered, but raise other questions about implementation. This high-level summary of the U.S. healthcare system will, of course, raise additional questions, but it is relevant to the paper`s argument that new advances in telemedicine are available to expand access to health care to more people and improve patient outcomes. Since costs are often the biggest concern for millions of uninsured people, innovations in service delivery can reduce costs while reducing opportunities for waste and duplication of services. As seen during the coronavirus outbreak, appropriate public policy is more likely to foster the adoption of telemedicine practices, which is why Congress and federal agencies such as the Federal Communications Commission (FCC) must continue to promote remote access in the future. The Federation of State Medical Councils (FSMB) defines telemedicine as „the practice of medicine using electronic communications, information technology or other means between a licensee at one location and a patient at another location, with or without an intervening health care provider.” The FSMB definition was included in its model guideline to help state medical associations manage this emerging area of practice, which spans multiple states and areas, and to ensure patient care and safety.5 In general, federal laws were permissive or hostile to the regulation of telemedicine. In the past, the federal government has been involved in regulating telemedicine initiatives under the medicare program. But Medicare has been slow to change the restrictive norms for telemedicine use. For example, under outdated standards created before the advent of telemedicine, medicare limits reimbursement for this practice to people living in rural areas and can only be performed at authorized „sites of origin,” which excludes a patient`s home.40 Recent federal guidelines aimed to expand the use of telemedicine to more patients by providing services that could be reimbursed under Medicare. were extended to renal care and acute stroke. In addition, responsible care organizations have had more flexibility to pay for telemedicine services in other places such as the home.
But overall, restrictions on what Medicare can afford continue to hamper the use of telemedicine practices. Some employers include telemedicine in their benefit plans. In a 2014 Towers Watson survey of 1,000 employers, about 37% of employers reported that telemedicine options were included in their employee plan in 2015, and 34% said they planned to add this option in 2016 or 2017.13 The addition of telehealth services to benefit plans is an attempt to minimize the use of expensive emergency room services. A second factor motivating employers is the reduction or potential elimination of the free time an employee needs to physically travel to a doctor`s office. Second, there is the trade-off between privacy and usability. This is where the principles of „value architecture” can come in handy. Does all telemedicine need to be integrated into current electronic health record (EHR) systems to comply with data protection regulations? This choice results in a system where the only access to information is through cumbersome EHR systems. The imposition of such a requirement could lead to a balkanization of the information that patients and doctors need to avoid errors, waste and duplication.
What if, instead, patients` medical records were stored in secure databases that provide instant access to current history, test results, and medications? Lessons learned from the relaxation of HIPAA during the COVID-19 pandemic can be useful in rethinking patient data governance. For telemedicine specialists, this scope of practice presents a number of logistical challenges. While there has been a significant amount of government policy activity to increase the use and reimbursement of telemedicine, health care providers continue to face conflicting and confusing policies regarding insurance claims requirements, standards of practice, and licensing.19 Each physician must be informed of both the state in which he or she practices and the state in which the patient resides. be admitted. that may interfere with use and accessibility. Portability of approval between states remains a contentious issue, and many believe it is holding back the growth of telehealth services.19 The United States is the only developed country in the world without universal health care. Instead, the country has a hybrid public-private system in which individuals get their health insurance from their employer through a public program like Medicaid or Medicare, buy it directly from the market, or have no health insurance at all. While a detailed description of the entire U.S. healthcare system is far beyond the scope of this paper, the context provides the reasons why telemedicine initiatives need to be available to mitigate the lack of universal access, variable costs to patients, and quality care. After all, private health insurance is already sold and regulated at the state level, reinforcing its role at the epicenter of health policy.
Payers can decide how telemedicine can help them meet their coverage obligations under government regulations.48 In addition to working with network providers, some payers have contracts with third-party providers to provide telehealth services to their members.49 Some private payers and Medicaid programs have recognized the need for incentives and have announced payment parity for telemedicine for the duration of for example, for a routine GP visit, such as a 20- to 30-minute doctor visit, Louisiana Medicaid reimbursement for 2020 would be $33.95 for a telemedicine visit (current procedural terminology (CPT code 99443), compared to $62.65 for a physical visit (CPT code 99214). This pay equity is a necessary step, as there has been a significant change in some clinics that has increased the proportion of telemedicine visits from 10% before the pandemic to over 90% during the pandemic.6 The regulatory change in pay equity must be maintained post-pandemic, and adequate reimbursement for telemedicine will be an important factor in maintaining broad adoption. Without these changes in reimbursement, some small practices, particularly in rural areas, could face financial hardship due to reduced physical clinic visits. „The main problem with payment parity laws is that they contradict the cost-effectiveness of telemedicine.” A number of states have begun to review their regulations on telehealth services and the definition of the patient-provider relationship.