Telemedicine is defined as the practice of medicine using electronic communications where the patient and the provider are in different locations. Before the COVID-19 pandemic, there was very little telemedicine practiced in the US. Of course, physicians and patients have talked on the telephone since its invention. Some insurance companies even had policies designed to reimburse physicians for time spent on the phone, particularly for coordinating care for patients with complex problems. Nevertheless, most ‘old-fashioned’ telemedicine was delivered for free.
Beginning early in 2021, lawmakers, policymakers, third-party payers, and health systems scrambled to implement (or, in some cases, ramp up) telemedicine programs. This policy change was implemented to limit personal contact between patients and avoid incidental gatherings in waiting rooms and hospitals. Telemedicine implementation required the rapid design of reimbursement policies and substantial loosening of privacy requirements that had been in place before the pandemic.
Traditional Telemedicine Restrictions
When implementing telemedicine policies, several overarching guidelines must be met. First, there must be a mechanism to establish a physician-patient relationship. Second, patient data must be private. This requirement derives from the privacy standards mandated by The Health Insurance Portability and Accountability Act of 1996, or HIPAA.
During the COVID-19 pandemic, several of these restrictions were relaxed. Regarding privacy, it is essential to point out that telephone communications have never been HIPAA-compliant; one does not require sophisticated equipment to hack into standard telephone lines (although the practice is strictly illegal without court-approved warrants). All other electronic communications, according to HIPAA, must be secured in some fashion to maximize privacy; this is the case even for e-mail.
The pandemic created conditions in which some of these privacy restrictions needed to be lifted. The reason is that many physicians’ offices lacked the software or resources to implement HIPAA-compliant telemedicine systems on short notice. The Centers for Medicare & Medicaid Services needed to rapidly approve reimbursements for office visits and other services that occurred via telemedicine.
The Future of Telemedicine Healthcare Policy
By early 2021, it remained unclear whether COVID-19-related changes in telemedicine healthcare policy would stay in place when the pandemic ended. Many patients enjoyed the convenience of consulting with a physician without having to drive to an office or clinic. Many physicians as well appreciated that they could provide excellent care and be appropriately reimbursed.
The future of telemedicine will likely depend on policymakers and insurance companies. If the technologies meet privacy requirements and insurers continue to pay for those services, the likelihood is that telemedicine will be a permanent fixture in healthcare delivery.