One of the offshoots of the coronavirus pandemic has been a surge in both awareness and use of telemedicine services. Published estimates suggest that the use of telemedicine during the early days of the outbreak in the United States soared to anywhere from 20 to nearly 80 times what it had been during comparable time periods the year before. This boom was aided by federal regulatory waivers that expanded physician reimbursements for Medicare-related telemedicine services and temporarily suspended penalties for failing to adhere to certain telemedicine protocols. While those numbers have subsequently declined, telemedicine usage remains significantly higher than in pre-pandemic days, and will likely continue to grow, in part due to ongoing government activity in this area.
Even before COVID-19 hit our shores, federal regulatory and legislative efforts had been focused on increasing access to telemedicine services. The Centers for Medicare & Medicaid Services (CMS) routinely expanded the list of telemedicine services for which reimbursements would be provided in the annual Physician Fee Schedule update. In addition, Congress regularly takes steps to increase access to specific services via telemedicine.
In 2018, for example, legislation was enacted to allow telemedicine to be better utilized for treating substance abuse, another bill was signed into law to increase telemedicine treatments for stroke victims, and yet another bill was passed to waive state licensure requirements for Veterans Administration physicians treating patients across state lines. While undoubtedly providing a valuable benefit to many Americans, this expansion of telemedicine does not come without risks, especially when the interstate provision of telemedicine is involved. Questions remain about how health professional licensure and scope-of practice requirements are to be enforced, what liability laws apply, and who is responsible when technology issues hinder telecommunications on either side of the patient-physician interaction.
Thus far, Congress has failed to address any of those issues—and not because they are unaware of them. The Medical Professional Liability Association has repeatedly raised these concerns in individual meetings with members of Congress, before congressional hearings, and with the Congressional Telehealth Caucus, and we will continue to do so as federal legislators take additional steps to address telemedicine issues.
The expansion of telemedicine services is a win-win for both patients and healthcare professionals. Whether it remains that way will depend on what steps our elected leaders take to address the numerous questions that expansion entails. Regardless of whether the issue is reimbursement, liability, or access, it will be critical for healthcare stakeholders to remain informed and engaged so that those leaders are held accountable for their acts (or failure to act) regarding the future of telemedicine.