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PRESIDENT’S
MESSAGE

Telemedicine:

Will it Survive the Pandemic?

By Gerald Q. Greenfield Jr., MD, 2020 BCMS President

The current COVID-19 pandemic has led to changes in the forced state and federal government agencies to drop the payment
practice of medicine all over the world. Beginning in March 2020, barriers to delivering medical care by telemedicine. Beginning in
many practices in Bexar County and in Texas began a transition to March and into April 2020, due to the public health emergency,
telemedicine. Aside from clinical concerns regarding the adequate the Centers for Medicare and Medicaid Services (CMS) relaxed cer-
delivery of medical care, economic and technology constraints ini- tain regulations. This enabled "all beneficiaries across the country
tially limited this practice. The initial days of telemedicine forced (to) receive Medicare telehealth and other communications tech-
physicians to either shut down their practice for an indefinite pe- nology-based services wherever they are located." Medicare also
riod-of-time with zero revenue or adapt to the new system. greatly expanded payment for these telehealth services; and this is
The practice of medical care delivery by what is now called to continue for the duration of the public emergency. The Texas
telemedicine began in the military. In order to provide adequate Department of Insurance (TDI), as well as many of the largest
care to deployed forces with a limited number of physicians, a new commercial health plans, have followed the lead of CMS in pro-
technique of communication and care-delivery was developed. viding reimbursement for telemedicine services.
Often through the use of cameras and secure communication tech- Due to the ongoing pandemic, many patients have welcomed
niques, medical care in austere environments was provided at a the opportunity to continue their medical care from the safety of
highly sophisticated level. In the original telemedicine scenarios, their homes, offices, or even vehicles through the use of telemed-
communication from frontline providers was often with some of icine. While this was initially a challenge to some physician offices,
the most highly trained clinicians in the military, located at medical as time has passed it has become more and more efficient. This
teaching facilities. This enabled those frontline providers, such as was initially literally a telephone medicine consultation. Now the
combat medics and physician assistants, to provide medical care at use of smart phones and computers has added a video component.
higher levels of sophistication in a combat environment. While This has allowed patients to reduce the risk of exposure to the
this did not allow the performance of surgical procedures, it did virus and to save time and money involved in visits to a physician
enable appropriate decision-making for the individual patient. This office. For physicians it has often made medication adjustments
insured that those patients who needed to be evacuated from front- easier and more rapidly accomplished. The increased flexibility will
line medical treatment facilities could be identified. hopefully allow physicians to provide the highest level of medical
Efforts by the Texas Medical Association in the 2017 legislative care during and even after the current healthcare emergency.
session achieved coverage parity for telemedicine visits for a cov- In a recent survey of Texas physicians, over 80% of respondents
ered service. However, the new law did not mandate payment par- do or plan to offer telemedicine services to their patients. This in-
ity. This meant that healthcare plans were not required to pay cludes a majority of both surgical and nonsurgical specialists. There
physicians the same for a telemedicine visit as was paid for a similar are, however, limitations to the use of telemedicine. It is much
in-person visit. The onset of the current COVID-19 pandemic more useful in the treatment of established patients or for follow-

8 San Antonio Medicine • November 2020