COVID-19 pandemic has influenced the rapid adoption of telehealth by providers across the country. During these times many providers were forced to completely switch to telehealth. Both providers and their patients experienced the benefits of telehealth.Continue reading
The population of the U.S. is aging. Today, there are more than 46 million adults aged 65 and over – which makes up roughly 14% of our population.1 This number is expected to keep growing rapidly and reach 22% by the year 2050. This is a significant increase from the 1950s when only 8% the of the population was 65 and over.1 In this decade, the last of the baby boomers will reach the age of 65, and it is projected that by 2030 1 in 5 people in the U.S. will be 65 and over.2Continue reading
During the pandemic, many patients and providers got a chance to experience the benefits of telehealth. While this opportunity was enabled by the loosened regulations due to the state of emergency, the future and application of telehealth and remote patient monitoring is now in the hands of the healthcare lawmakers that determine reimbursement policies.
In the 2022 Physician Fee Schedule, the Centers for Medicare and Medicaid Services proposed an extension of most of the COVID-19 relaxations until the end of 2023. Such extension would allow for sufficient time to assess which services should be permanently kept after the public health emergency. In addition, the proposal extends coverage for telehealth sessions treating substance abuse and mental health issues.
The other proposed changes include the elimination of geographical restrictions, allowing the patient’s home to be the originating site for the mental health video telehealth coverage, with a requirement that there is at least one in-person visit every six months. When it comes to audio-only telehealth, CMS proposed changes to their previous requirements. If passed, these changes would allow for audio-only telehealth to be used for mental health diagnosis, evaluation, and treatment.
“CMS is proposing to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology,” the agency said. “CMS is also proposing to require the use of a new modifier for services furnished using audio-only communications, which would serve to certify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations.”1
CMS also proposed expansion of Medicare coverage for real-time mental health telehealth treatment provided by FQHCs (Federally qualified health centers) and RHCs (Rural health clinics). As of right now, neither FQHCs nor RHCs have been listed as distant site telehealth providers. Such expansion of Medicare coverage can make a tremendous difference for underserved populations.
Expansion of RPM (Remote patient monitoring) coverage is still being discussed.
“Notably, the current proposal does not include any changes to the use of RPM CPT codes. This comes as a disappointment to many who had hoped CMS would remedy the limitations imposed by the 16 days’ transmission requirement,” states Carrie Nixon in a blog.4
However, the 2022 Physician Fee Schedule includes a new category of CPT codes called “remote therapeutic monitoring”. The new RTM codes with previously introduced RPM codes give healthcare providers more options for reimbursement. This proposal has greatly expanded what was understood by RTM, however, there are still plenty of unknowns and details that need to be clarified. It is expected that these unknowns will be clarified in the upcoming months so that the providers can confidently plan to implement or enhance existing telehealth and remote patient monitoring offerings.
Any feedback on the 2022 Physician Fee Schedule propositions must be submitted by September 13th, 2021.
Being a medical provider requires more than just medical knowledge. Emotional care in the providers’ approach is equally important. Providers around the world take pride in patient care. Gaining patient’s trust and establishing a positive relationship with them are the key components of providing the best care to the patient. Over time, as the patients and providers get the opportunity to build up a positive relationship with one another, providers can deliver more personalized care and increase the likelihood of achieving a better outcome. Having an established relationship will allow a patient to confide in provider, while also trusting that the treatment and guidance provided will help them achieve the best outcome possible.
With the rise of the COVID-19 global pandemic, providers, many of which have never used telemedicine before, have turned to technology to provide the best patient care possible at these unprecedented times. At the same time, many patients that have previously never used telemedicine are booking virtual appointments. When it comes to in-office visits communication, both patients and providers have certain expectations. However, with telemedicine, not only that the patient has a harder time establishing a relationship with the providers, but also the experienced providers with many years of patient care under their belt struggle. How to gain patient’s trust while remotely communicating via mobile devices? Providing a better patient experience in a virtual setting is a skill and requires time and practice to perfect. Furthermore, there are several things to keep in mind when starting to offer remote patient care.
First, spend time educating your patients on telemedicine. The concept of telemedicine is still foreign to an average patient, especially the elderly. Make sure that you discuss the virtual visit with your patients beforehand. Ask them how comfortable they are with the telemedicine setting, if they have a device compatible with the telemedicine tool you are using, and if they have good connectivity to join-in for their appointment. Answer their questions and provide them with a guide on how to prepare for their appointment.
Secondly, anticipate the chance of experiencing technical difficulties. Prepare a course of action in case your patient is experiencing an issue. Will you connect on a phone call or will you reschedule? Will a staff member help troubleshoot the patient’s issue or is there a troubleshooting guide provided by the telemedicine provider you are using? Minimizing the unknowns will make your patients feel more confident and open to trying out this new form of communication.
Thirdly, do not forget eye contact. Maintaining eye contact can be hard when you are trying to look at different screens and notes. Make sure to tell your patient what you are doing so that they do not feel uncomfortable when you are looking at EMR or take notes.
Ultimately, telemedicine is a tool to help better patient care. As telemedicine becomes more incorporated in the healthcare system, the comfortability and confidence of both patients and providers will grow.
1. Toh, Nathan, et al. “Telehealth and Patient-Doctor Relationships in Rural and Remote Communities.” Canadian Family Physician Medecin De Famille Canadien, College of Family Physicians of Canada, Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5154642/.
2. M;, Dorr Goold S;Lipkin. “The Doctor-Patient Relationship: Challenges, Opportunities, and Strategies.” Journal of General Internal Medicine, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/9933492/.
3. Kelley JM;Kraft-Todd G;Schapira L;Kossowsky J;Riess H; “The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.” PloS One, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/24718585/.
4. Olsen, Russell, et al. “How to Create a Patient-Focused Telehealth Experience.” MedCity News, 4 June 2020, medcitynews.com/2020/06/how-to-create-a-patient-focused-telehealth-experience/?rf=1.
Consumers today are driven by the idea of utilizing technology to maximize efficiency and convenience in every aspect of their lives. Getting adequate medical care is no different. More and more consumers are seeking medical care outside of the traditional in-person office visits. Telemedicine is appealing to consumers, as they can get the treatment for routine needs without unnecessary travel and waiting time with just a few clicks on their devices from the comfort of their homes.
This year has challenged many sectors to seek ways to continue their operations while complying with stay-at-home orders and social distancing guidelines.
When it comes to non-urgent medical care, providers turned to the practice of telemedicine. Before COVID-19, there were many strict regulations in place governing how and where telemedicine can be used. Telemedicine regulations govern many things including which providers can bill for telemedicine services, what acceptable originating site (patient location) for telemedicine appointments are, etc. Consequentially, many patients did not have access to telemedicine because they did not fall under the categories listed in the policies.
As the COVID-19 emerged, many of the regulations and policies governing telemedicine have been loosened and continuously updated to accommodate the current state of emergency. These changes brought an unexpected outcome of establishing the benefits of telemedicine by helping patients continue their treatment with doctors remotely without the risk and fear of virus illness contraction. Many patients that would normally not be able to access telemedicine were able to receive care from the comfort of their homes and get timely follow-ups and refills.
However, most of the current regulations allowing access to telemedicine are only temporary and will not be valid once the COVID-19 public health emergency is over. There is a strong need for congress to make access to telehealth permanent and update the pre-COVID-19 telemedicine regulations.
Virtual care has proven to be beneficial and can have a critical role as a supplemental tool in the future of medical care.
ATA has provided a document listing variety of issues regarding telemedicine practice, the policies and regulations governing them before and during COVID-19, as well as their recommendations for new policies for the post-COVID-19 world.
The unexpected global outbreak of COVID-19 has undeniably influenced the increased usage and awareness of telemedicine in providers and patients that may have never used or heard of telemedicine before.
When introduced to telemedicine, many believe that it is a modern invention. This assumption is understandable considering all of the technology that modern telemedicine incorporates — video calls, mobile and smart devices, remote robotic surgeries, internet connectivity, etc.
However, the concepts of telemedicine and remote patient care, as well as the need for it was recognized hundreds of years ago. The home-based remote patient care was mentioned as early as 1879. An article published in Lancet, one of the world’s oldest and best-known peer-reviewed general medical journals, mentions the use of the telephone in patient treatment to cut down unnecessary in-person visits.
In the 1920s, the world was introduced to groundbreaking technological innovations including radio and broadcasting. Innovators quickly started utilizing new technologies to create designs and prototypes. One of them was a man called Hugo Gernsback, an inventor and a publisher passionate about technology, who made significant contributions to the growth of early broadcasting. In 1925, Gernsback wrote an article on a device he named “teledactyl”. In his article, he described how teledactyl would allow the doctor to use radio signals to receive a video feed of the patient and remotely control robotic arms to examine the patient. Gernsback’s designs were precursors to the modern telemedicine tools we know today.
The invention of the radio also facilitated the ability to conduct remote consultations between clinics on ships and experts on the mainland, resulting in improved patient treatment. Similarly, the remote consultations via radio allowed providers in remote areas to seek advice from their peers.
Today, we have the capability of utilizing universally available phone service and internet connectivity to conduct phone and video visits envisioned by Gernsback. The continuous improvements in network speed and latency made robot-assisted remote surgeries possible.
Technology is still advancing and the possibilities for the future of telemedicine are endless. The constant advances in telecommunications and technology will keep influencing the transformation of the healthcare system that we know today. Telemedicine can help us overcome the barriers of location dependencies in healthcare.
It is important to note that the growth of telemedicine is constrained by the existing regulations and policies in place. However, with the rapid growth of telemedicine, it is expected that the regulations governing telemedicine will be constantly updated and expanded to include new technologies and use cases.
- “The Evolution of Telehealth: Where Have We Been and Where Are We Going?” The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary., U.S. National Library of Medicine, 20 Nov. 2012,
- Novak, Matt. “Telemedicine Predicted in 1925.” Smithsonian.com, Smithsonian Institution, 14 Mar. 2012,
The US Federal government took a number of significant steps to increase the availability and use of Telemedicine during the Covid-19 pandemic. Although these measures are temporary and subject to revision in future, the widespread use of Telemedicine as a useful tool to fight the constraints of the pandemic is expected to help establish its viability as a mainstream healthcare service.
The US department of Health and Human services (HHS) introduced flexibility in allowing consumer communications applications such as FaceTime, Zoom, Skype etc. without any risk of penalties imposed for HIPAA violations. However. it also encourages providers that seek additional privacy protections to use technology vendors that provide HIPAA compliant platforms. Vivadox.life has been built incorporating advanced encryption technologies to ensure privacy protections.
The Centers for Medicare and Medicaid services (CMS) made it easy for enrolled patients to use Telemedicine from their homes. To encourage providers to offer the Telemedicine option, CMS will be reimbursing telemedicine virtual appointments at par with many in-person appointments and has significantly expanded the list of services eligible for Telemedicine. Providers are also allowed to offer their Telemedicine services across state lines subject to any specific requirements set by states for the duration of the Covid-19 Public Health Emergency. Providers are allowed to see new patients via Telemedicine and not just established patients.
More details can be accessed here
All major private payers including UnitedHealthCare, Cigna, Aetna and Anthem have announced significant telehealth coverage options including parity with in-person visits, waiver of patient cost sharing for in-network providers as well as originating site restrictions.
More details can be accessed here as well as directly with the private payers.
Assessing the benefits of telemedicine and telehealth overall and using them to enhance existing courses of treatments can make a huge difference. Telemedicine allows you to continue monitoring your patients even when they are out of your reach.
A great example of how telehealth can make a huge difference in the patient outcome is Harris County Public Health that has implemented telehealth tools to help tuberculosis patients stay on track with their treatment. Tuberculosis can be spread though air via coughs or sneezes. In 2017, when Hurricane Harvey hit Texas badly, they were able to provide continuous treatment and support to the patients. Patients would record themselves taking their therapy for the staff to review at a later time. In addition, patients had a way of reaching their case manager quickly in case they faced any issues. As a result, not only that the 97% of the patients took their treatment as instructed, but the disease was also not spread in the community.
Similarly, New York Presbyterian specialists used telemedicine to help treat the victims of Hurricane Maria in Puerto Rico as a part of emergency response. On-site team helped set up telemedicine equipment that enabled the communications with the specialists in New York. In this scenario, telemedicine was used for consultation – the New York specialists consulted local specialists on patient treatment, while also being able to see and hear the patients. This set up helped establish trust between both the providers and the patient.
These are examples of how telemedicine helped when traditional medicine was out of reach. We are still to see how powerful impact of telemedicine can truly be.
Start a conversation
Telemedicine is new to you, your team, and your patients. Ask your colleagues about their experience with telemedicine so far. They may have some concerns or questions, but they may not be comfortable starting the conversation about it. Or they may have some suggestions on how to make telemedicine even a bigger success for your practice. Seek feedback from your patients as well. You may get some valuable insights and learn about things you can improve in your processes to make your patients’ virtual visits better.
Introduce your patients to telemedicine
Spend time talking to your patients about the telemedicine option you are offering. If appropriate for their case, offer them to try it for their next appointment. Provide them with sufficient information on what telemedicine is and how it works and be prepared to answer any additional questions they may have.
Use telemedicine capabilities to the fullest potential
Understand how to get the most out of the chosen telemedicine platform. Learn about features that you maybe did not initially considered, but that may help you make your processes more efficient and improve patient care. Communicate your feedback and any new requirements to the chosen telemedicine platform vendor to get improvements that will allow you to provide even better care with telemedicine.
Find ways to measure the impact of Telemedicine
As a practice that is just starting to use telemedicine, it is important that you have a way of telling if and how telemedicine has impacted your practice – both in the context of patient care and revenue. Metrics will help you understand where you are comparing to where you want to be. Some of the metrics you can easily gather and analyze are:
- How many telemedicine appointments have you conducted as a practice (or per provider)? This metric can tell you if your patient is comfortable using telemedicine practice as well as if your investment in such telemedicine platform is justified. Have in mind that it will take some time for both you and your patient to get used to the idea and become more comfortable booking telemedicine visits.
- How many patients were satisfied versus unsatisfied with this form of interaction? If the platform you are using allows for the patient to rate how satisfied they are with their telemedicine experience you can use this information to see if your patients find this service valuable.
- How many patients did cancel their scheduled appointment or never showed up? This information can indicate whether or not your patients are confident in using telemedicine. This parameter can be a good indicator if you need to educate your patients more on what telemedicine is and how it works, as well as to reassess if you are picking the right type of patients for these visits (and right type of conditions).