By Susan Bailey, MD – AMA President
This piece was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
It happened twice in the same morning.
I saw two women for checkups that morning—their stories were so similar. Both older but not elderly, living alone, physically impaired needing a walker or motorized scooter, and always very crabby at their appointments. A litany of chronic non-specific complaints—fatigue, aching, headachey, etc. Honestly, I was not looking forward to their visits. They never seemed satisfied, and I never felt like I had helped them much. When I saw them both on the schedule that morning, I confess that I grimaced a bit.
But their telemedicine visits were just the opposite of their usual in-person visits. They both were happy, smiling, and relaxed. The conversations were easy and their questions were few. I anticipated much COVID-19 anxiety but found little; they were used to staying at home and hadn’t had to change their way of life much. They both just needed refills—I would have liked to have done a physical exam, but I really didn’t need to.
At the end of the morning, I wondered to myself what was different, and then it hit me. They didn’t have to physically come to see me, which so many of us take for granted but for them was likely a physically draining, frustrating, expensive, humiliating, and even painful experience. Wow. Was I humbled.
Telemedicine is a gift to some of our patients, such as parents stuck without childcare who have to bring multiple children along with them, people who lack reliable transportation, or elderly people who don’t like driving anymore but are embarrassed to ask for a ride. It can help someone two hours away who just needs a refill or a patient who can’t afford to miss work. I could go on and on; I’ve seen cases like every example I’ve given and I’m sure many of you have, too.
The coronavirus pandemic has added a new layer of urgency to the implementation of telemedicine. Physical distancing and shutdowns have made it extremely difficult, if not impossible, to see our patients safely face to face (especially when PPE is still hard to find). Telemedicine enables routine care to continue without the risk of exposure to the virus. It keeps medical offices safe and in business.
The AMA, along with many other organizations, has been developing telemedicine policy and recommendations for years. The AMA House of Delegates approved a report from the Council on Medical Services laying out principles for coverage and payment in June 2014.
An AMA survey in 2016 showed that 15 percent of physicians worked in a practice that utilized telemedicine in some way.1 But a far smaller percentage of actual patient encounters were done via telemedicine.
When COVID-19 struck and communities were shutting down all over the country, the telemedicine guidelines, reimbursement policies, and the work we had already done with CMS helped the organization be ready with their new guidelines for coverage and payment, which were initially released on March 17, 2020.
AMA had been working with the Physicians Foundation, the Texas Medical Association, the Florida Medical Association, and the Massachusetts Medical Society to create the Telehealth Initiative to provide a wide array of assistance for physicians to implement telemedicine in their practices.2 The launch of the program was not scheduled until later in the year but instead was moved up to March 19, 2020, just two days after the CMS announcement.
Virtually every medical society in the country now has guidance available for physicians on using telemedicine.
However, the current telemedicine coverage and payment program will only stay in effect as long as there is a national emergency, which has now been extended to the end of October 2020. Of course, we all know that COVID-19 will not be gone then, so AMA is working with state and specialty societies to lobby Congress for permanent solutions.
I believe that every specialty will develop its own guidelines for the appropriate use of telemedicine going forward, and every practice will utilize telemedicine to some degree.
The genie is out of the bottle. Let’s hope it stays that way. We deserve to be compensated fairly for services regardless of location, and our patients deserve the ease of access.
References
1. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05077
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