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Over the past several weeks, we have seen unprecedented changes to rules, edits and other measures traditionally put in place to stave fraud, waste and abuse in the healthcare industry. With the current state of affairs, the floodgates have been opened. The most talked about changes, or at least the one that most seem to want to talk about in the various social media outlets, is telehealth and telemedicine. I have written many blogs about telehealth and telemedicine in that past, so why not continue to beat this horse dead.
I have always believed that the telemedicine regulations prior to COVID-19 from the Medicare perspective, were a bit behind the technology curve. A many can agree, the government is sometimes a bit slow to catch up to the technological advancements that are out there. Each week, we see another iteration of the rules being changed. The most current iteration involves the allowance of telemedicine and telehealth by nearly any practitioner, including physical therapy, occupational therapy and speech and language therapy. At some point, however, the continued relaxing of rules will undoubtedly become permanent rules. Without reading any tea leaves, I firmly believe that it is more difficult to take something away after it has been given, than to give something that was not available.
I am certain that there will be some level of permanency to the current telemedicine and telehealth rules, and rightly so. As the Medicare population moves and shifts over generations (and I discussed this in a blog several weeks ago), the use of technology will become easier. The question though, from my fraud waste and abuse lens, is what is the line that gets drawn on the use of this technology. Can physical therapy and occupational therapy truly exist in a virtual environment? I do not really know the answer, but there are certainly treatment modalities that require that special “hands-on” that only come from true face to face care. Just as a dentist is not really able to perform a procedure in a virtual environment, there has to be a limitation placed on how telemedicine and telehealth is really implemented.
In a recent discussion I had with someone, there was an analogy made between taking a virtual yoga class via a social media platform and having a physical therapist oversee exercises in the home. My main contention was that physical therapists are able to take empirical measurements, make a hand- on correction, and take action with the patient to ensure that the patient is actually making progress. Keep in mind that Medicare is very specific regarding the circumstances under which it will pay for such therapies. Please understand that I am by no means taking issue, per se, with physical, occupational, or speech therapy modalities. I am merely saying that each instance where telemedicine and telehealth are expended to peripheral treatment regiments really does have additional collateral consequences.
My final thought is that so many providers that were never involved in telemedicine and telehealth, and are now getting involved in it, maybe running afoul of documentation and care-related issues, be held accountable to those problems later down the road, and not even be aware there is a problem.
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