Will Telemedicine Gains Remain After the Pandemic? Four Neurologists Weigh in.

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services instituted unprecedented expansions to their policies on telemedicine reimbursement. This has dramatically dropped barriers that had been slowing progress in this arena.

The question being batted around now is: When the pandemic ends, we still have this same expanded access to telemedicine?

Dr. Jaime M. Hatcher-Martin

We called up four neurologists – Dr. Heidi Schwarz, Dr. Kim Hutchison, Dr. Laurence Kinsella, and Dr. Jaime Hatcher-Martin – and posed that question to them.

“In a good way we’ve sort of let the cat out of the bag,” says Hatcher-Martin. Here’s what else they had to say, with their answers lightly edited for clarity.

Heidi Schwarz, MD

“Our institution strongly feels that telemedicine is here to stay. The thought is: studies will show that this is equivalent as far as quality of care.

“There are already studies out there showing that patients often prefer this mode of physician visit. With telemedicine they don’t have to have their child or their spouse take a day off to go with them, schlepping from place to place when they’re exhausted.

“Assuming that the reimbursement we’re experiencing now continues, our department is banking on 50 percent of our visits remaining telemedicine visits. We’re certifying all of our chief residents on how to do telemedicine because we feel like this is going to be so much a part of their practice going forward.”

Kimberly Hutchison, MD, FAASM

“I think that the video visits will stick. The rapid adoption has shown that both providers and patients can do it effectively.

“Hopefully payers will recognize the benefit. Ultimately there are fewer resources utilized in video visits than there are for in-person visits. You don’t have to have the brick and mortar. Because of out-of-control costs in the healthcare system, this is sort of holding a mirror up to potential cost savings, and it would be silly to not adopt it post-COVID. 

“In neurology we’ll be limited somewhat in what complaints and diagnoses allow for effective telemedicine. So, we’ll always need to see patients in person. One concern that I have is just the loss of connection with patients. There’s something very healing about human touch and not having that ever with your patients is a detriment to the relationship. My ideal would be that patient visits would be mixed.”

 

Laurence Kinsella, MD

“I don’t think we’re going to be able to put the genie back in the bottle. I don’t see us going back to the previous reimbursement model, where it was very difficult to get paid for telemedicine. I think it is also going to lead to us charging for phone calls.

“I don’t think they can leave the rules as liberal as they currently are, for instance the whole full state licensure thing. If they created a certification for telemedicine that transcended state licensure — that I think would be an ideal follow up of this.

“You know, neurologists really like to touch the patient, but 90 percent of diagnoses are made by the story. There’s actually a surprising amount we can learn through a tablet computer or the phone even.”

Jaime M. Hatcher-Martin, MD, PhD

“In a good way we’ve sort of let the cat out of the bag. I think patients are seeing that it’s not just about people that can’t travel, it’s also convenient. It helps reduce the risk of infection. They don’t necessarily have to take as much time off work. I think physicians are realizing too that you can really see a lot of people for checkups and still provide quality care. There’s something to be said for seeing patients in their own environment.

“My suspicion is that it’s going to be kind of two steps forward, one step back. I think there are certain things that are going to probably get pulled back in. One of those being phone call evaluations. Right now, they are billed and reimbursed at the same rate as video evaluations in an effort to reduce any kind of disparities between people who have access to the technology. I don’t think that is going to hold.

“I think the push from both the physicians and the patient side is going to be there. And I think we’ve kind of been heading this way for a long time – unfortunately it took a pandemic to tip it over.

Special thanks to:

• Heidi Schwarz, MD, Professor of Clinical Neurology, University of Rochester Medical center, Rochester, NY. She specialises in headache medicine.
• Kimberly Hutchison, MD, FAASM, Associate Professor of Neurology and Sleep Medicine at Oregon Health & Science University in Portland, Oregon. You can learn more about her on her website.
• Laurence Kinsella, MD, neurologist at SSM Health Neuroscience Institute, St. Louis, MO. He is board certified in internal medicine and neurology and specializes in neuromuscular medicine, electromyography and autonomic disorders.
• Jaime M. Hatcher-Martin, MD, PhD, is a movement disorders specialist working as a neurologist for SOC Telemed. She was on the COVID emergency telemedicine work group for the American Academy of Neurology.

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