Should Medicare’s Telemedicine Be More Widely Used?

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What is telemedicine (sometimes referred to as telehealth)? It is the ability to have a virtual office visit or consultation with a doctor who is not present in the patient’s area. Medicare Part B covers 80% of the cost of these virtual communications (the deductible applies). The goal is to achieve an interactive two-way conversation, including audio and video in real time, between a doctor and patient who are not in the same location.

This is particularly helpful for rural residents; indeed, the program is aimed at them. Telehealth or telemedicine as of 2015 was available only on a limited basis. Medicare patients whose “originating site” (the place from which they were communicating) was an officially designated rural Health Professional Shortage Area (HPSA) could access Telehealth. Other Medicare beneficiaries who could take advantage of Telemedicine had to be located outside of a Metropolitan Statistical Area (MSA) or live in a rural census tract. In 2014, other areas were included, even if these areas were on the outskirts of metropolitan areas, if the Office of Rural Health Policy defined their residential areas as rural.

Telemedicine for All Elderly Persons?

Impediments to Telemedicine’s use may be the fact that the virtual communication must take place from an approved facility, such as a doctor’s office, hospital, clinic, or other health center or facility. This means that the convenience of Telemedicine is somewhat compromised because the person still has to travel to a health site. In rural areas, travel options for the elderly are often quite limited.

Of course, difficulties with transportation hold true for most elderly persons and their caregivers, not only for rural residents. For an elderly person who no longer drives yet lives in an urban or suburban area, getting to the doctor still can be a big undertaking. A simple trip of a few suburban blocks can seem as difficult as going to the moon.

Donna (not her real name), who was a caregiver for her mother says that doctor’s visits were something the whole family dreaded. Extremely feeble, Donna’s mother spent almost all her time in bed or in a lounge chair in the living room. She could no longer walk and had to be pushed in a wheelchair from room to room. Donna said, “Getting Mom to the doctor was no small thing. She could no longer shower or dress herself. At home she pretty much lived in her nightgowns and housecoats. To be taken out in public, of course, we would dress her so that her modesty was preserved. We would have to hire several strong people and a special car to get her into the vehicle, and then into and out of the clinic, then back into the house and into her special chair or to bed. Yet the doctors would blithely say, ‘Bring her in to see me again on such and such a date’ seemingly without an idea of the hardship they were imposing on her and on us. Some of the appointments were just consultations; the doctor didn’t even examine her. She had mild dementia too, so any interruption of her routine disturbed her. We would all be worn out after a simple doctor’s visit.”

Advocates of Telemedicine want the program to expand beyond serving a limited rural population.

Donna’s mother could have benefited from Telemedicine—even more so if it could have been done from a home computer equipped with a camera. Advocates of Telemedicine want the program to expand beyond serving a limited rural population. They see Telehealth as the wave of the future, especially for elderly, infirm, weak patients who have enough caregivers to age in place at home but for whom a doctor’s’ visit is so dreaded it is something to be avoided.

Location, Location, Location

Part of the rationale for Telemedicine is to reduce costs. Advocates are anxious to see costs as well as anxiety and other difficulties reduced by the more widespread use of this available technology. Some see the system as being under-utilized due to its restriction predominantly to rural areas. Although services that are covered have expanded (they now include annual wellness visits, psychotherapy for families and the patient, and ongoing office visits for long-term illnesses) they have not expanded beyond the rural restrictions.

Telemedicine or Telehealth may be the wave of the future for rural residents and elderly shut-ins and invalids for whom a trip to the doctor might as well be a trip to the moon. Lifting the restrictions on the “originating site”—perhaps allowing a home computer to be used if a bona fide health care worker is present during the conferencing— may go a long way toward easing the difficulties many older people, rural and otherwise, face when visiting a doctor.

 

Sources

U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Medicare Learning Network. Telehealth Services. Rural Health Fact Sheet Series. Available online at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf. Retrieved December 17, 2015.

Medicare.gov. (website). Official U.S. Government Site for Medicare. Your Medicare coverage. Telehealth. Available online at https://www.medicare.gov/coverage/telehealth.html. Retrieved December 17, 2015.

Wickland, E. (November 3, 2014). CMS boosts telehealth in 2015 physician pay schedule. mHealthNews. Available at http://www.mhealthnews.com/news/cms-boosts-telehealth-2015-physician-pay-schedule. Retrieved December 17, 2015.

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