September 18, 2020

Getting Healthcare during a Pandemic

The COVID-19 pandemic is changing the way we live in so many ways, including how healthcare services are being accessed: over the internet. If you’re sheltering at home to help stop the spread of coronavirus, but need to see a doctor, telemedicine—receiving medical care via digital technology—is a promising alternative to an in-person appointment.

According to a recent survey conducted by the Harris Poll for the telemedicine provider, Updox, 42% of people surveyed have used telemedicine (also called telehealth) since the start of the pandemic. 65% of survey participants said it is more convenient than in-office appointments, and 63% noted appreciation for not having to worry about being exposed to other potentially ill patients. Other benefits mentioned in the survey included how much easier they thought it was to schedule an appointment via telehealth compared to an in-office appointment (44%), and that follow-ups/communications were more streamlined (38%).

“Technically, there are three types of telemedicine: synchronous, asynchronous and remote monitoring,” explained Jeffrey S. Durmer, MD, PhD, Chief Medical Officer at NOX Health and RLS Foundation Board Member. “Synchronous refers to care that is provided with a live patient typically through a secure video link. Asynchronous, also known as ‘store and forward,’ refers to the act of collecting medical information, including examination data, imaging, laboratory results, etc., and then storing those items for reference later by a physician. Remote monitoring includes collecting behavioral and medical data using cloud enabled devices, software programs, and treatment hardware that can transmit data to remote providers. Remote monitoring can be either synchronous or asynchronous by nature of the patient being present or not, but usually it is asynchronous.” Tele-based programs on health education, behavioral modification, and psychological and social support also fit under the umbrella of telehealth.

Telemedicine for RLS

Dr. Durmer, whose research focuses on the neuroscience of sleep, says telemedicine is a great way for people with RLS to stay connected with providers, especially for sleep-related disorders since there are few sleep clinicians and centers located in the US.

“Telemedicine allows increased access to sleep care and improved management of sleep conditions by specialists. So, common issues like sleep disordered breathing, insomnia, restless legs syndrome, and circadian rhythm disorders are a natural fit for sleep telehealthcare,” he said, adding that more complex disorders may not be suited to telemedicine. “The use of telemedicine in sleep healthcare can augment much of our current face-to-face follow up using remote monitoring and synchronous tele-follow-up appointments.”

Prescriptions for medications usually can be obtained during a telehealth visit as well. Due to the coronavirus pandemic, the Drug Enforcement Agency is now allowing doctors to prescribe controlled substances and schedule II narcotics, such as opioids, during telehealth sessions as long as the medication is being issued for a legitimate medical condition in the clinician’s practice; the clinician follows all state and federal laws; and the telemedicine visit is synchronous, allowing for real-time, two-way communication.

“Outside of the current emergency decree, physicians are generally able to prescribe controlled substances by telemedicine if they have first had a face-to-face encounter with the patient prior to the telemedicine encounter,” said Durmer.

The future of telemedicine

Until now, telemedicine had some important caveats to consider. Stringent coverage rules, geographical issues, in which laws limit the practice of medicine across state lines, and other factors have created significant limitations for patient and providers. However, the coronavirus pandemic has pressured lawmakers to make some substantial changes. Now, the effort among many is to keep those previous barriers in the past permanently.

“Medical insurance plans have resisted the implementation of telemedicine, and prior to COVID-19, placed undue financial and operational burdens on clinicians and their patients in order to utilize telemedicine,” said Durmer. “Some states enacted ‘parity laws’ making it illegal for payers to pay less for telemedicine care than in-person medical care. Insurance companies have found ways around these laws by requiring physicians who want to get paid for telemedicine care to join insurance telemedicine networks. ese insurance-controlled networks often impose operational hurdles such as specifying the use of one electronic medical system, applying for approval to the insurance company telemedicine network and other obstacles that make it difficult for many physicians to even get started.” Medicaid and Medicare also put restrictions on telemedicine reimbursement, making it harder for recipients to engage, although after COVID-19, the government did issue a waiver that now enables greater participation.

“It took a devastating event—the COVID-19 pandemic—to rally the public and local legislators in an effort to extend the use of telemedicine as an equal and often better delivery model for US healthcare,” concluded Durmer. “Many organizations associated with healthcare policy are lobbying state and federal officials to maintain the current emergency telemedicine care guidelines beyond the COVID-19 pandemic, since it is clear that this methodology optimizes care delivery while maintaining a high standard of practice. An additional benefit of moving more care to the telemedicine environment is that by providing clear technology standards for this sort of practice, the ability to objectively measure patient care pathways, medical decisions, and patient outcomes become much more efficient and effective.”