from the Institute for Patient Access
By Jill Farmer, DO, MPH
Health care providers don't always have a lot of free time on our hands. But when it comes to policies that impact our patients, we find the time to speak out. I’m thinking specifically of telemedicine, which has allowed my patients with Parkinson’s disease to continue treatment during the COVID-19 pandemic.
Telemedicine allows patients to use their phone, tablet or personal computer to see their health care provider remotely. The capability is vital for people who are uncomfortable leaving the house and having in-person visits during COVID-19. Many of my patients are grateful for the opportunity to keep their appointments, rather than having to cancel or wait months for care.
While telemedicine visits have their limits, they allow me to observe my patients and see their movements virtually. I can also ask questions about patients’ symptoms and concerns. Telemedicine provides a powerful bridge to care during difficult times, like a pandemic, and also for diseases, like Parkinson’s, that make it tough to regularly travel to a medical clinic.
Some worry that increased telemedicine will lead to the end of in-person patient care. I disagree. Health care providers want to see their patients at the office. Equally important, physical exams demand in-person care, as do initial patient visits in many medical specialties.
There is a rising demand for quick, easy-access health care options, though. Think of the Minute Clinics and urgent care facilities you see popping up across the country. In some ways, the traditional care model already has begun to shift.
But I’d say that telemedicine offers convenient, timely access while still connecting patients to their own health care provider, who knows them and their medical history. Telemedicine fulfills patients’ growing desire for flexibility without sacrificing the physician-patient relationship.
For those reasons, I’d like to see telemedicine capabilities remain even after COVID-19 dies down. That will require policymakers to commit long-term to several policies implemented during the pandemic.
Reimbursement is key. Medicare, and then many commercial insurers, began paying health care providers for telemedicine visits back in March. The policy change made virtual and telephone visits financially viable for health care providers, many for the first time.
Continuing to provide telemedicine will require ongoing payment parity – reimbursing health care providers for virtual visits and in-office visits at the same rate. Fairly reimbursing health care providers for their time and expertise, whether it be an in-office visit or a virtual one, allows clinics to pay their staff, keep the lights on and continue serving patients.
Policymakers should also consider eliminating site-of-care restrictions, which stem from insurance companies’ reimbursement system. When a doctor’s office is attached to a hospital or institution, the insurance company reimburses for a “facility fee” in addition to the cost of the visit itself. If health care providers conduct telemedicine visits outside of the facility, the hospital or institution loses this fee. These artificial and restrictive fee structures must be addressed. Health care providers and patients can, and should be able to, have a virtual visit from any private location.
Lastly, policymakers must overcome the fragmented nature of coverage policy. Medicare policies apply to beneficiaries across the country. But for non-Medicare patients, laws that impact insurance coverage can vary widely state to state. The hoops patients have to jump through to get coverage are confusing, even for clinicians who have been practicing for years.
Providers can and should advocate for policymakers to bring these changes to fruition. Continued access to telemedicine can help ensure that patients are not left without care. Making that possible is a worthwhile use of time for us all.
Jill Farmer, DO, MPH, is a neurologist at the Global Neurosciences Institute and a member of the Alliance for Patient Access.