Virtual house calls get health care ‘to more people, at a lower cost’

[Editor's note: This story originally was published by Real Clear Health.]

By David H. Adams, MD
Real Clear Health

As the deadly COVID-19 pandemic once again surges across America, many shortcomings of our health care system remain in sharp relief, as well as clear opportunities for improvement. One of these opportunities is expanding the use of telemedicine to deliver better care to more people, at a lower cost, in the safety of their own home.

As a heart surgeon who specializes in repairing heart valves, I understand the need for hands-on medical care as much as anyone. But in the early days of the pandemic, when my hospital had to suspend all but the most urgent clinical visits, my team and I were surprised to learn how well we could evaluate and advise patients via telemedicine.

Evaluating medical imaging and offering face-to-face consultations with patients using the web proved highly effective, as well as preferrable. It reduced the need for most patients and family members, many of whom live across the New York tri-state area and around the country, to come to the hospital for consultation prior to surgery. Telemedicine enabled them to meet with us via video from the comfort of their own homes – reducing anxiety, travel and unnecessary exposure risk.

Since the Centers for Medicare and Medicaid Services (CMS) approved delivery of more than 80 new services via telemedicine earlier this year, more than 11.3 million of the program’s beneficiaries have accessed such care from the safety of their own homes, and that number grows daily.

Unfortunately, our authority to help patients remotely is only temporary, granted for the duration of this public health emergency. Based on what we’ve learned, though, many of my colleagues across the country are urging federal and state authorities to make this authority permanent. By permanently expanding medically appropriate telehealth options, we can dramatically improve our health care system.

One analysis found that telehealth programs in the Veterans Administration reduced hospitalizations by as much as 40 percent, saving $6,500 for every enrollee. Telehealth can also help reduce unnecessary emergency room trips for patients with chronic conditions, improving long-term preventive care while lowering costs.

In addition to permanent telemedicine authority, another reform we seek is nationwide reciprocity in medical licensing. Currently, an amalgam of state-by-state licensing requirements prevents most specialists and other medical experts from providing diagnostic services, even second opinions, outside of their own state.

This is not only inefficient but unfair, because it denies Americans in rural and other under-served areas equal access to a full range of medical expertise and care, and increases costs for everyone. During the COVID-19 pandemic, CMS and many states have temporarily removed such barriers to care by recognizing the credentials of certified health professionals, regardless of which state licensed them. This temporary, live-saving reciprocity should be made permanent.

If this pandemic has taught us anything, it’s that a piecemeal or parochial approach to public health undermines everyone’s safety. By contrast, if we were to pair reciprocal licensing with permanent telehealth authority, providers everywhere could better collaborate to optimize health care for all Americans, including those who need to visit hospitals for hands-on treatment, or just need a second opinion to make a more informed decision about their own care.

In a sense, by leveraging our collective expertise and the power of modern technology, telemedicine can revive a lapsed yet beloved tradition in American medicine – the house call – to deliver much of the care that many patients need, virtually. Implemented at scale, this commonsense approach will improve efficiency, enhance safety, lower costs and, most importantly, improve our patients’ health.

Ultimately, all Americans deserve access to quality, affordable medical care, no matter where they live – and not just during a pandemic. Telemedicine can help us provide that. The time for reform is now.

David H. Adams, MD, is the Marie-Josée and Henry R. Kravis Professor and System Chairman of the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System. He is also President of the Mitral Foundation, and a past President of the American Association for Thoracic Surgery.

[Editor's note: This story originally was published by Real Clear Health.]


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