Before the COVID-19 pandemic, Lyndi Church, the medical director of the Caring Hands Healthcare Center in southeastern Oklahoma, and her colleagues were interested in telemedicine, but they worried that it would not work in rural areas of the state.

Many residents in this area lack reliable broadband or have no equipment or technology to use telemedicine services. Church, the chief operating officer of Caring Hands, expects significant resistance. “We are not sure how our patients will accept it,” she said.

Then the pandemic hit and everything changed.

Early on, Caring Hands stopped treating patients in its facilities. Health workers saw some patients in the center’s parking lot, but other than that, Church said all medical care was performed virtually. To her surprise, even though mobile and broadband services are sometimes unstable, patients still choose telemedicine.

“Most of our patients are very grateful for this service, especially when they are afraid to enter the office,” she said.

The surge in the use of telemedicine services during the pandemic has opened up many medical service providers and patients to the convenience, efficiency, and relatively low cost of telemedicine. But its future largely depends on whether state legislators expand emergency measures to make telemedicine a viable alternative to patients and providers who are cautious about face-to-face contact. The most important changes made in most states are to expand Medicaid coverage to different types of virtual appointments and to develop telemedicine coverage requirements for private insurance companies.

Mei Wa Kwong, executive director of the Interconnected Health Policy Center, a non-partisan organization widely regarded as a telemedicine authority, estimates that the number of telemedicine visits increased by 40% in the spring and summer of 2020, still before the pandemic.According to a survey conducted by the National Association of Community Health Centers, the percentage of health centers using telemedicine From From 43% before the pandemic to 98% in the months before the crisis.

Kwong wrote in an email: “The temporary telemedicine policy has helped so many people get care that they would not have or might delay getting until it becomes a more serious problem.” National Bank“Sudden cancellation of access due to policy changes may have a significant adverse effect on many people.”

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Many states have extended temporary telemedicine measures, which will expire when the public health emergency is lifted, and other states are also considering doing so. Kwong estimates that the state legislature has more than 1,000 telemedicine bills pending, many of which will allow more services to be provided in a virtual manner or require public or private insurance companies to provide coverage for these services.

There is no organized opposition to the legislation, but it is not clear how many providers are willing to use telemedicine once patients feel less anxious about exposure to the coronavirus.

“It’s all about change management, teaching people to do things differently in practice,” said Mary Zelazny, chief executive of Finger Lakes Community Health in rural upstate New York, before the pandemic Telemedicine was used, but it increased during the crisis.

She said that telemedicine has increased the efficiency of her medical center, saved money and improved care.

“We won’t go back.”

Permanent change

Many of the pending telemedicine bills are related to the Medicaid program, which is a federal/state joint health program for low-income Americans. According to data from the National Conference of State Legislatures, 27 states have used relaxed federal rules to expand Medicaid coverage for telemedicine services.

For example, many states including Arkansas, Connecticut, Kentucky, and Vermont have permanently authorized Medicaid programs that cover only audio-only medical consultations and no video components. Colorado, Kentucky, and Mississippi have enacted legislation to ensure that post-pandemic Medicaid reimburses telemedicine services provided by community health centers. From now on, New Hampshire will require its Medicaid program to pay providers the same amount of telemedicine and in-person visits.

Arkansas has also approved a law that permanently extends Medicaid coverage to a large number of behavioral health and drug use services provided through telemedicine. The state’s Medicaid program now covers remote treatment provided by psychologists, clinical social workers, and marriage and family counselors. It also includes crisis intervention, drug use evaluation, group therapy for patients over 18 years of age, and mental health diagnostic evaluation for patients under 21 years of age. Last spring, both houses of the Arkansas State Legislature approved these measures without a negative vote.

Dr. Lee Johnson, the Republican state representative who supported the Arkansas bill, said that during the pandemic, he began to realize that behavioral health services are particularly suitable for telemedicine. Generally speaking, no physical examination or laboratory work is required, and greater privacy is provided for patients who may be concerned about the stigma of visiting a mental health provider.

“If you are in a small community or even a larger community, you have to see a psychologist or psychiatrist, maybe you are worried that someone will see you,” said Johnson, an emergency room doctor. “This allows you to stay at home anonymously and still access these services.”

Congress allowed Medicaid and Medicare to pay providers for telemedicine services provided to patients at home, and also removed the limited restrictions on the location of providers, thus clearing the way for states. It also expands coverage to different types of telemedicine services and providers, as well as audio-only appointments that were previously excluded.

Colorado takes advantage of new rules Telemedicine service Provided by physiotherapists, occupational therapists, hospice workers, family health providers, and pediatric behavioral health professionals who are eligible for Medicaid reimbursement. The state also stipulates that family health agency services and treatment, hospice care, and pediatric mental health services can be provided over the phone. However, all of these changes are related to the ongoing public health emergency in Colorado, and it is not clear whether they will extend beyond this.

During the pandemic, Medicare, a public health program for the elderly in the United States, also relaxed many telemedicine reimbursement rules. The Biden administration announced this summer that medical insurance will continue to cover virtual behavioral health services, but the Centers for Medicare and Medicaid will evaluate other telemedicine services before deciding whether to expand the coverage beyond 2024.

Supporters of telemedicine, including the National Community Medical Services Association, are pushing Congress to make these changes permanent.

More than twenty states have also established some permanent telemedicine insurance requirements for private insurance companies. For example, after the pandemic is over, Arizona, Iowa, Massachusetts, and New Hampshire will require private insurance companies to cover all telemedicine services and reimburse providers at the same rate as face-to-face services. At least four states—Massachusetts, North Dakota, Vermont, and Washington—have extended the requirements for private insurance companies to reimburse audio-only consultations, but they are not necessarily permanent.

State laws regarding private insurance companies usually only apply to personal health insurance policies or insurance policies that employers do not pay. Employer-funded programs are regulated by the federal government.

Obstacles still exist

Although the patient has Embrace telemedicine The choice during the pandemic does not guarantee that they will continue to do so after the pandemic is over. Kim Schwartz, chief executive of the Roanoke Chowan Community Health Center in rural eastern North Carolina, said that at the height of the pandemic, 90% of primary care visits were done virtual. Now, 80% of her patients are in person, even if it means long-distance driving.

“Culturally speaking, the motivation for convenience is not as important as face-to-face relationships,” she said.

Schwartz pointed out that broadband availability and computer knowledge are still obstacles. Nonetheless, she said, telemedicine must be part of her center’s future because of its advantages in expanding limited human resources. She said the challenge is to improve patient comfort.

Rural areas are not the only areas that hinder greater use of telemedicine. Dr. Sachin Shah, physician and researcher at the University of Chicago School of Medicine, Study racial differences Telemedicine was used in southern Chicago during the pandemic. Many of his black patients live in urban communities, just like in rural areas, struggling with broadband access, computer knowledge, and technical availability.

Shah said: “This makes a large part of our patient population very vulnerable.” He said that many of his black elderly patients who do not have smartphones benefit from temporary changes and telephone consultations can be reimbursed. He said that policymakers must consider inequality when drafting telemedicine measures.

Although the barriers of the pandemic and the unique environment make telemedicine a top priority, many in the healthcare field insist that the service has proven its value in supplementing face-to-face medical care.

“This is not the result of careful planning; it fell on our lap,” Shah said. “But this is a great opportunity. I don’t want to see us go backwards.”