Understanding Telemedicine: what is it, how does it work, and what are the pros and cons?

Since the start of the COVID-19 pandemic, the new buzz is about Telemedicine…or is it Telehealth? It doesn’t matter, but everyone is using it and talking about it. STOP. Wait. Hold on, not so fast. Is it Telemedicine or Telehealth? And it does matter?

e-Health

There’s a whole new world out there in healthcare and that world is the world of e-Health, aka – digital health, and there are a few more terms it can be classified as but for our discussion we’ll keep at e-Health. So, what is it? The “e” stands for electronic, or it means – digital, or “IT” – that is, information technology. Yes, this is the new medicine.

Healthcare (the entire field of delivering healthcare services, e. g. patients, providers, payers, technology, pharmacy, hospitals, etc.) or medicine (the direct delivery of care to a person) has always been slow to move in the direction of IT mainly because Doctors are slow to change from their writing in the charts to documenting using computers, cell phones and now Telemedicine, to deliver care.

e-Health is about any and all services that are now required to be electronic – including the medical records. The government mandates, mainly by the Centers for Medicare and Medicaid – the single largest payer in healthcare – the use of electronic medical (health) records (EMR). The point of this is an attempt to reduce medical errors in prescribing medications, diagnoses, treatment plans, etc. because people made mistakes trying to read the handwriting, plus it was slow and just plain – old. Furthermore, it was difficult to track and trend processes of care. Therefore, there needed to be a strong push to go from the 19^th Century methods to the 21^st Century – and fast. And since CMS is the big Gorilla – as the largest US payer, when they speak, everyone listens. Along with this came many other technologies like Telemedicine and remote patient monitoring, just to name a few.

Telemedicine v. Telehealth

So, what is the difference between these two, or are they the same with different names? First, they are not the same although they are used interchangeably and incorrectly. Telemedicine (TM) is the remote electronic care of people by a healthcare provider, be it a Primary Care Provider (PCP) or specialists. Their professional designation must be a medical doctor (MD), a doctor of Osteopathy (DO), an Advanced Nurse Practitioner (ANP), or a Physician’s Assistant (PA). In the case of the ANP and PA, they must be functioning in the capacity of a PCP, which means they need to have been trained and certified in that field.

Telehealth (TH), on the other hand, can be any licensed healthcare professional other than a PCP or specialists, such as an RN, pharmacist, Physical Therapist, Occupational Therapist, etc. Or ,TH can be the remote electronic use for training and administrative functions. Nevertheless, the terms will, no doubt, continually be used interchangeably.

For the rest of this article, however, now that we are educated on what Telemedicine and Telehealth are, we are going to use the proper term – Telemedicine. This is to mean exactly what we all think: engaging with a PCP or a specialist remotely. Remember, anyone else is Telehealth. Understanding this could save you money; see below.

What is needed for Telemedicine to occur?

For the most part, all that is required for Telemedicine is an electronic piece of equipment to communicate remotely with your provider, e. g. a laptop, cell phone with visual capability, and/or a telephone. However, understanding this is important because some Telemedicine and Telehealth services may not be covered by your insurance. If that’s the case, you might be billed directly.

That said, a telephone call is a form, and one of the oldest forms, of Telemedicine. It just wasn’t called this; instead, it was, “I spoke to the Doctor on the phone.” That was it, nothing special. However, that Telemedicine phone call may not be covered as a billable Telemedicine event, and that’s because some insurance companies don’t consider a phone call as Telemedicine. Why not? Who knows. Someone does not like telephones, I guess. However, if you are a patient with any two or more chronic conditions, every insurance who pays for Chronic Care Management should pay for a Telemedicine phone call because it’s covered for Chronic Care Management patients. More on this below.

Purpose of Telemedicine

The use of Telemedicine has been terrific for many reasons. It has bridged many gaps in the delivery of healthcare. For example:

Follow-up visits
Remote patient monitoring
Chronic disease management
Care for those in rural communities
Remote post-hospitalization care. One telemedicine program for patients with congestive heart failure reduced 30-day hospital readmissions by 73 percent and six-month readmissions by 50 percent!
Preventative care support
School-based Telemedicine and Telehealth
Assisted living center support
Senior nursing care facilities

Daily, there are new studies and articles showing newer uses of Telemedicine. Telemedicine was growing very slowly pre-COVID pandemic. However, during the pandemic its growth and use exploded. One of the reasons for the previous slow growth was due to policies, politicians, and insurance payers. All three had unproven notions that Telemedicine and Telehealth would be abused, and costs would increase. The pandemic proved otherwise. The rules, guidelines, policies, and payments all dramatically began to change by necessity – and to the benefit of the country and to people and providers. It will never go back to where it once was. Telemedicine and Telehealth are accelerating in their growth and usage.

Pros and Cons to Telemedicine and Telehealth

Cons:

Reimbursements: This is one of the major issues with both Telemedicine and Telehealth. Reimbursements are inconsistent and a function of the laws in respective states. This is because many lawmakers do not know what you now know. Therefore, their thinking is old-fashioned. Nevertheless, they are being forced to change to accommodate the crisis and urgent need for more providers using 21^st Century methods of healthcare delivery. This means one of the most difficult issues to overcome are the cross-state licensure of providers. If you live in one state – New Jersey, for example – and you see a Doctor in NY and need a Telemedicine visit, your NJ insurer may not pay for the service. If that’s the case, you’ll need to change to a Doctor in NJ or pay for the service out of pocket.

This is an easy fix: change the law allowing for cross-state Telemedicine care. Many state legislators have done so. Hopefully, after the pandemic, they won’t revert back.

Medicaid is notorious for not paying for all kinds of reasons. I think this is discrimination against the poor and underserved. However, Medicaid is a state-run payer. Medicare is federally operated with different rules.

Telemedicine and No PCP Visit: Too many healthcare companies use Telemedicine for first contact care, eliminating face-to-face visits. To me, this is cheating. Meaning that, as a physician, I believe you need to be seen in person at least once per year, if they’re considered your PCP. How can there be any real substitute for healthcare?
Proper Equipment: As you’ve learned, without the proper equipment neither Telemedicine nor Telehealth can be conducted. Therefore, there are many people, mainly seniors and the poor, who may not be able to benefit from these technologies.

Types of Payers: As previously mentioned the types of payer can and will determine if these services are paid for by your insurer. No doubt, the services are available; that’s no longer in question. The issue is payment.

Pros:

Healthcare Equity: Everyone knows there’s no healthcare equity in the American healthcare model, although too many in “leadership” positions would like to think otherwise. Both Telemedicine and Telehealth can close the gap of the lack of healthcare access to those least served. This remains the greatest benefit of Telemedicine and Telehealth: their ability to increase the access to care. This is one instance where not being seen in person may be prudent. The people who can’t get to the Doctor’s office, e. g. those who are home-bound or geographically “too far”, are well-served by this technology.