Timely interactions between patient and doctor foster a long-term relationship and build continuity of care – a simple, yet an often-overlooked aspect of our nation's healthcare system. Maintaining continuity is important for patients with chronic conditions like diabetes. A doctor familiar with a patient's case will know when to take appropriate actions: Are there new complications, or a need for different medications?
Research shows that an established doctor-patient relationship results in fewer and shorter hospitalizations, improved patient satisfaction, and more consistent utilization of preventive services. However, face-to-face interactions are sometimes not possible: when the patient must tend to child care; when the patient is unable or can't afford to travel; or when a COVID-19 infection has resulted in an appointment cancellation. Missing an appointment could result in long-term adverse effects for the elderly or infirm.
While the current pandemic has exposed these deficiencies, it also has accelerated the development and adoption of a promising solution: telemedicine — a convenient substitute for many traditional visits that can help preserve continuity. Telemedicine is cheaper – an average of $38 versus $114 for an office visit; it diverts the patient's use of more expensive settings such as emergency care, generating long-term savings: $19 to $121 per visit. And it reduces no shows. It also offers a safe alternative when providers may be at risk of getting infected from sick patients.
Telemedicine has limitations. A doctor cannot "feel" the patient (think abdominal examination), which is why traditional office visits must not be abandoned, but rather supplemented through telemedicine.
Even with all the upsides, patients and providers have been slow to embrace telemedicine. A survey by Amwell, a telemedicine company, found that less than 8% of Americans had a telemedicine visit, while 96% of us own a cellphone, according to Pew Research Center. The lingering barriers include: complex regulatory matters; lack of established standards by commercial insurers; restrictions on teleservices covered by Medicare; reluctance to embrace something new; and confidentiality concerns.
COVID-19 has forced us to innovate and reconsider telemedicine. Medicare and Medicaid agreed to cover a broader array of telemedicine services for as long as the crisis lasts, with many commercial insurers following their example. But, what happens when the crisis is over? How can continuity be maintained?
Policymakers can seize this moment to reform the way primary care is delivered and elevate the telemedicine option. They can start by removing barriers to adoption, such as — in the case of Medicare — abolishing certain eligibility requirements for reimbursement for telemedicine visits, especially those for rural patients.
State legislatures and regulatory bodies could simplify licensing processes, especially for qualified doctors and those willing to serve as family physicians already licensed to practice in other states. All levels of government should invest in infrastructure to enhance broadband connectivity.
Ensuring wider availability and use of telemedicine post-pandemic would benefit patients, providers, and the system. The continuity of care for the chronically ill could be increased by avoiding the "one-and-done" interactions with random practitioners. Forming long-standing and consistent patient-doctor partnerships will improve our nation's overall health.
Like other sectors, the large-scale implementation of telemedicine will also spur development of complementary innovations, as witnessed with mobile health applications and home-based point-of-care testing that use smart devices to track and transmit patients' data, leading to enhanced continuity of care. Overall, this will not only improve the U.S. healthcare system but also help prepare us for the next, inevitable, crisis.
Ahuja is an assistant professor of operations management at the SMU Dallas Cox School of Business and an adjunct faculty at the University of Texas Southwestern Medical Center. His research focuses on decision-analytics that improve patient health.
©2020 Austin American-Statesman, Texas. Distributed by Tribune Content Agency, LLC.
