COVID-19 has changed the landscape of many things: job security, the stock market, access to health insurance, and the capacity of the healthcare system as a whole. Hospitals in the United States are currently at or exceeding capacity in their emergency departments, and there is a growing need for and shortage of beds, personal protective equipment (like gloves and masks), and healthy physicians. One way states are trying to save capacity for their sick COVID-19 patients is to ban elective surgeries and routine appointments for a period of time, to save space, time, energy, and resources for our sickest patients.
Unfortunately, when you live with diabetes, you usually need to see your physician (typically an endocrinologist) several times a year for HbA1c blood work, refills on prescriptions, and to adjust dosing requirements with changes in diet, exercise, and hormonal changes (brought on by life stage, stress, or pregnancy). What some offices are doing to make space for both is to offer telehealth appointments.
What Is Telehealth?
Telehealth is the distribution of healthcare services via telecommunication technologies, like phones and computers. It allows long-distance patient and physician communication, care (such as check-ups), health advice, important reminders, monitoring of conditions, changes to therapy (like adjusting insulin doses), and can even allow for remote admissions to hospitals.
Who Can Utilize Telehealth?
Most private health insurers will cover telehealth appointments, although there is no set standard for covering this kind of care.
A total of 48 state Medicaid programs cover telehealth, which can prove beneficial in rural settings when a lack of transportation, lack of patient mobility (such as a disability), or shortage of local or regional staff restrict access to care. In these instances, telehealth services can bridge that gap. The Medicare Fee-For-Service Program will cover telehealth from originating sites (like a hospital or healthcare facility) to patients who live in rural areas, Health Professional Shortage Areas, or a specified county outside of a metro area.
In the United States, over 76% of hospitals utilize telehealth to better serve their patients, yet you may still have never heard of this service! Additionally, 35 states and DC have enacted “parity” laws, which require health insurers to cover services provided via telehealth the same way (and the same amount) they would reimburse for services provided in person.
If your health insurance company doesn’t cover telehealth services for you and you need advice from your doctor, most physicians are willing to accept self-pay for the service. Some patients are willing to pay out of pocket for the convenience of getting their care via telehealth, although that’s not reasonable to expect for the general population.
Improving Access to Telehealth During COVID-19
In response to the COVID-19 outbreak (and under President Trump’s National Emergency Declaration), the Centers for Medicare & Medicaid Services (CMS) expanded access to Medicare telehealth so that patients can receive a wider range of services via the platform. The benefit is being expanded for all Medicare beneficiaries under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Acts. These steps are to ensure that all Americans, especially older Americans who are more susceptible to severe complications if they contract the virus, are aware and can take advantage of more accessible healthcare benefits, while socially distancing themselves to prevent the spread of the virus.
According to CMS, “Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.” An expanded range of providers such as traditional doctors, but also nurse practitioners, clinical psychologists, and licensed clinical social workers will now be able to offer telehealth to patients.
The waiver also provides flexibility for physician groups to reduce or completely waive copayments and cost-sharing for telehealth visits for Medicare patients. Additionally, under this waiver, telehealth visits are considered the same as in-person visits, and are paid at the same rate as traditional, in-person visits.
Which Types of Providers Typically Use Telehealth?
Typical telehealth services are those rendered by physicians (including endocrinologists!), nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, licensed clinical social workers, registered dietitians, and nutritionists. This, of course, can vary by state and state law.
How Do I Get Started?
If you need to see your physician or endocrinologist, and want to try telehealth, call their office and see if they currently take advantage of such technology. If they do, they might have you download a compatible, HIPAA compliant platform for chats and video conferencing, or you may even be able to use your own telephone and FaceTime or Skype. It’s important to also check with your health insurance company to make sure they cover for such services, so you aren’t stuck paying out of pocket, which can quickly become prohibitively expensive.
The Future of Telehealth
Despite some reimbursement and HIPAA challenges, there are incredible benefits to increasing the utilization of telehealth to meet the needs of a growing and aging population. Also, with COVID19 preventing many physicians from seeing patients in-person, and high-risk groups like those living with diabetes warned to stay home, telehealth makes the most sense to both protect patients while concurrently meeting their healthcare needs. The convenience of care, improved access for both physicians and patients, efficiency of no commuting time or waiting room eunni, and time savings for everyone make telehealth the ideal choice for patients and physicians alike, and we should see these trends continue into the future.
Have you utilized telehealth to help manage your diabetes care? What did and didn’t you like about the experience? Share this post and comment below, we love to hear your stories!