Healthcare will change immeasurably. The most obvious and immediate benefit is the massive acceptance and adoption of telehealth. During the preceding five years, when technology was developed and readily available there was only a tepid acceptance and usage of telehealth. Social distancing and a lockdown of almost the entire United States and overwhelming demand for health services motivated insurance companies and Medicare/Medicaid to authorize reimbursement for telehealth services.
After one week of telehealth, I can see that the medical world is not going to be the same. Going to the doctor is a pain in the butt. As a board-certified pain specialist, I'm well qualified to say that.
For years patients would ask why I could not just "call-in" their medications. For routine medications, I'd tell them the truth, that I needed to assess them every so often for medication efficacy and side effects. For opiates and controlled substances, I'd add that due to DEA guidelines I could not "call" them in any way. Now that the regulations have been relaxed to encourage social distancing I can legally assess patients via video chat, even when they live just around the corner from my office. Add in electronic prescribing of controlled substances (EPCS) and now I can send in that prescription.
My patients, providers, and staff are still working out the mechanics of a telehealth visit. It's been amazing though. We implemented work from home for most of the staff and telehealth for 90% of office visits in 1 week. Providers are figuring out what you can learn by just looking at a patient. Who knew that a knee effusion would be obvious on an iPad or that you can count respirations? Then the patient can demonstrate functionality, press on their own leg to test for edema, even perform a rudimentary neurologic and musculoskeletal exam. I want more data, like vital signs, but in this crisis, a telehealth visit is worlds better than nothing. A telehealth system that integrated with my EMR would be better yet. The best option would be a system that offered telehealth, EMR, and remote patient monitoring in a single platform.
For now, we are settling into a new normal, but what happens this summer (or fall) when we go back to seeing patients in the office? I highly doubt that Medicare is going to force the nearly 60 Million beneficiaries to go back to in-person visits for all non-rural care. On the other hand, I fully expect that HIPPA requirements will return. Whether the DEA allows EPCS with only Telehealth documentation is my main uncertainty. Here again, I'd bet that politics will lean towards patient satisfaction. Perhaps C-III and C-II prescriptions will get different guidelines. We will need (and get) new regulations on this. Plus, what defines supervision for my physician assistant when she works from home "seeing" a patient who is also in their home?
It's an open question as to how best to adapt to a telehealth world. I don't like doing new patient consults via video, but routine follow-ups have been fine. A business may be better. Patients may opt for more visits if they're easier. We'll be able to expand our catchment area since patients don't have to drive in to see us as often. But we'll also have more competition from outside providers who are able to see patients in "our" local region. I envision a less structured clinical day. Currently, I segregate surgicenter days from office days because the other providers are using those resources when I'm elsewhere. In the future, I could see telehealth visits from my device anywhere. We may need fewer support staff with fewer in-office visits. It'll be a whole new world and if we adapt we'll do well and if not we will lose out to those who do.
Published by
Brian Block, MD, PhD
Pain Specialist, Physician, Interventionalist
Telehealth is going to change Everything | LinkedIn
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