The obvious choice for this week’s discussion is the quick adaptation and implementation of telemedicine in the past year. Surprisingly, before the pandemic, telemedicine was already on the rise throughout the United States. Barnett et al. (2018) states that from “2005-2017, there were 383,565 telemedicine visits by 217,851 people”. According to Wheel (2020), “telemedicine visits increased at an average compound annual growth rate of 52% per year from 2005 – 2014”. The American Telemedicine Association (2021) shows that “from 2017 to 2023, the global telemedicine market is projected to grow at a compound annual growth rate of 16.8 percent”.
Working on an inpatient psychiatric unit, we are not using telemedicine due to our population and patients. The trends we see are related to the severity of the patient’s disease, increases in substance abuse, or the effect of de-institutionalization. To be honest, we have very little electronic equipment and documentation when compared to other hospitals. In fact, I do not believe that our hospital has an informatics nurse or similar position. The only example of big data we use at our facility would be our electronic documentation system. Overall, since the state/government runs the hospital, our equipment is always outdated, and we are always behind compared to similar hospitals. For instance, we did not get any form of electronic documentation until just a few years ago. In 2015, I was working supplemental at a nearby hospital and working at the state hospital. We were still documenting everything on paper in the state facility; meanwhile, everything was electronic at the other hospital. Even today, some of our patient and medication documentation is still completed on paper. Some of the challenges we face at the hospital with the EMR implementation is the resistance from older, more experienced nurses and data security. Some of the nurses at our hospital have been working at the hospital on the same unit for over 30 years. They have the mindset that they have always documented on paper, and it has worked just fine for them. They complain that the electronic documentation takes away from patient care/treatment. Some also state that the documentation is not user friendly, that it takes longer than paper documentation, and that some parts of the documentation require charting the same information in multiple places.
References
American Telemedicine Association. (2021, March 2). Telehealth Basics. https://www.americantelemed.org/resource/why-telemedicine/
Barnett, M. L., Ray, K. N., Souza, J., & Mehrotra, A. (2018). Trends in Telemedicine Use in a Large Commercially Insured Population, 2005–2017. JAMA, 320(20), 2147. https://doi.org/10.1001/jama.2018.12354
Wheel. (2020, February 13). Master Guide to Telehealth Statistics for 2019. https://www.wheel.com/blog/master-guide-to-telehealth-statistics-for-2019
sample response
I found your discussion on telehealth very informative and interesting. I agree that there was a huge disparity between in-person visits and telehealth visits when the pandemic began. CMS.gov (2020) states that only 15,000 fee-for-service Medicare enrollees received a Medicare telemedicine service each week before the COVID-19 pandemic. Since the start of COVID-19, CMS has added 144 telehealth services to Medicare’s coverage list, including emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.
Unfortunately, reimbursement for telehealth visits are still variable from state to state and insurance carriers. There has been some positive change to the Medicare and Medicaid reimbursement of telehealth visits, but little has been done to regulate private insurance reimbursement rates. Despite its popularity among patients and clinicians, the complexity of reimbursement rates and documentation rules across government and commercial payers is a hurdle for practitioners to adopt telehealth (Butcher, L., 2021).
Much more work is to be done in the reimbursement of telehealth visits; telemedicine has become a way of the future in healthcare for both acute and chronic conditions. If reimbursement continues to be challenged by the payers, practitioners are forced to decide between what is best for the patient and their own practice for survival.
References
Butcher, L. (2021). Support for telehealth remains, but reimbursement policies vary from state to state. Neurology Today. https://journals.lww.com/neurotodayonline/Fulltext/2021/07080/Support_for_Telehealth_Remains,_but_Reimbursement.6.aspx
CMS.gov, (2020). Trump administration finalizes permanent expansion of Medicare telehealth services and improved payments for time doctors spend with patients. Centers for Medicare and Medicaid Services.
https://www.cms.gov/newsroom/press-releases/trump-administration-finalizes-permanent-expansion-medicare-telehealth-services-and-improved-payment