Cspan. Org election. Interactive election vote tallies state by state. Balance of power in congress. Latest video on demand and about the election process go. To cspan. Org election. And this commune on the communicators, its a discussion about a growing form of telecommunications. And that is telemedicine. Joining us are dr. Joseph kavidar of the American Medical Association and Harvard Medical School, along with our guest reporter, Kimberly Leonard of Business Insider. Dr. Kavidar, how long has telemedicine been around . And whats been the growth or use of it in the past couple of months . Dr. Kavidar its been around some people think since the early 1920s. It was a lovely picture in one of the early magazines now poplar science. But it shows a family huddled around the radio having a visit ith the doctors. Really the 1960s is when it puttered along. We told everyone in the u. S. That we had to stay in our home and we as clinicians had to take care of them. How can it be use today . Well, it can be used in a number of ways. I think the best uses first of all, Mental Health is the number one probably used. God knows its a growing need. So that wonderful. A lot of urgent care type things such adds sore throats, ear aches and actually screening for the coronavirus is quite handily done. So virtual urgent care. And chronic management with patients with hypertension, diabetes, Heart Failure and the like are very handily done. During the pan dim k we did everything this way. Im a dermatologist. We did it this way. I think where were headed is what we call hybrid. Most people are pretty confident that we will continue to have telehealth as part of our care going forward. And there are a lot of reasons for that. We can get into them later. But most of those things and now even more. What i would finish off by saying not everything. And thats important. And really the conversation that you need to have with your doctor and for us as clinicians to be able to think through the information we need to make either a diagnosis or change a care plan. And if we can do that without touching the patient, then we can do it via telehealth. Well, lets bring Kimberly Leonard of Business Insider into this conversation to explore some of those issues. Great. Kimberly yes, doctor, thank you for being available for this interview. My understanding is that the Trump Administration had to make a lot of changes to rules to allow telehealth to be used in more doctors offices. Can you tell us what some of those changes were if those who are not as familiar . Sure. I was told the other day, i testified in front of the senate panel and i was informed that there were 31 to be exact. But i can only touch the highlights. The biggest one is that the federal government and most private pay ors came onboard with this are paying physicians and other clinicians the same amount of reimbursement for seeing telehealth patients as they would when they came into the office. That was a critical one. The second one was allowing us as clinicians to see our patients wherever they were. Medicare used to limit it to people in rural or Health Profession shortage areas. That went away. So i can be where i am right now, which is my home. And you could be where you are. And we could have a visit. And that would count. And we could bill for that. Regulatory er relaxation was in the area of technology and hipa. Hipa is a privacy standard rule that many people knew about. And it went away overnight. People could use google hang out. Or to tell se skype phone. But the third area was lie sense chure. And 4950 states have loosened their requirements so you can practice across state lines. Im in the boston area in eastern massachusetts. If you happen to come visit me. Lets say you live in new hampshire, and you came and visit me in the office. And we wanted to do a followup while you were in your home, we could dont that before because i wasnt licensed in the state of new hampshire. But now we do that. I think its those three areas that were a highlight. Kim ber ly President Trump thought that a lot of the changes might become permanent. We heard administrator on the centers for medicaid and Medicare Services stay the same. If you were to look at the landscape what are the important factors that need to remain in a post pandemic era. Yeah, thank you for asking. When i testified in front of the Senate Health committee and there was really strong bipartisan support for this. But were very helpful. But to be specific to answer your question, number one, we ave the originatting sight area. Thats number one on our list at the a. T. Afrlt. A. T. A. The send one that Rural Health Centers should be able to get reimbursed for providing you services that was not the case before. And importantly that the health the secretary of health and Human Services should be able to decide which services are reimburseable or not as part of their mandate. So those are three areas that are very important. There are many others, but were trying to be succinct here. It sounds as though some of these changes will happen through rule making but others will require legislation from congress, is that right . I believe so. Was a ginating cite rule statutory rule. And that would have to be a new statute to change that. Doctor, congress usually doesnt move this kickly. These things are happening quickly. These things are happening pretty fast, arent they . I was so impressed the other day when i was on the hill virtually. I actually was in the very same room testifying in front of them. But how committed the senators were at that hearing to move as fast as possible. You know, we have a term that weve weve coined called the telemedicine cliff. And what that means is that this isnt an abstract notion. I am back now seeing patients in the office at 40 of our previous volume. And when we get a little bit 75 . Cranked up well be at and we wont go higher than that. So in order for us to meet the demand for patient career we have to have telehealth embedded in our work force now. And if we cant do that and all of a sudden if our Public Health emergencies goes away and there is no way to fix these regulatory restrictions, then we will be in trouble and our patients will be in trouble. As a dermatologist, how do you diagnose this . The way we do it it turns out and this is research that i did maybe 30 years ago now. But your Smartphone Camera is quite adequate at taking good quality images. We have the patients submit that other the patient portal, which is of course, secure. And they wind up in my inbasket, in my electronic records. And we can do a video call or a phone call with them to go over and review the images. Rash, a le lesion or a lot of my patients that need a sixmonth or a skin check. That has to be done in the office. I said this idea of a hybrid environment is the way were going with this. Its critical that were able to do both. Kimberly yes, my understanding is that many and this is from talking to hospital c. E. O. S and to doctors is that theyre the amount of care theyve have increased. They planned to roll out in the next two years. And they ended up doing it in the next few months even. What percentage of doctor offices are happying over telehealth . And what are some of the biggest lessons that has come out with this . Yeah, thank you for that. So its one one thing ill say is that i am not always my to to be in profession, i think we mishandle things in my profession. This is one im proud because doctors that were involved, everyone jumped in with both feet. And we really havent had a bad patient outcome. Its been extraordinary. Of course, patients have always loved it. Patients are really when you can think about it when you can give patients what i call magical triad of access quality and convenience, everyones happy. And youll all everyone knows that the patient knows that the doctor knows it. So i say thats the Biggest Surprise is it went so well. I mean, where i work in boston in the Delivery System is called mass general brigham, we did 1600 virtual encounters. And now were up to 60,000 a week. And its gone pretty smoothly. Other Healthcare Providers are experiencing similar growth. You asked about how were going to settle out. Because we went from we went from only seeing people in the Office Overnight to only seeing people virtually, essentially. Except for emergencies, right . So we know thats not right either. And most people, its too early to tell but most people are thinking about 20 to 50 of their activities will be going virtual. Some people have said 70 . I think thats a little bit aggressive. But i think between 30 and 50 . And it does depend on your specialty. Ophthalmologist. Toy need to go to the office use all the gadgets for your eye condition. They might live in a part of the country where there isnt really good high speed internet. How do you get around those obstacles to make sure that this is something that patients can use or try or have as an option for them . Yeah, thanks, thank you for that. So one really, again, pleasant surprise from this and there have been a few. But one was that the health plans and the government started paying us for telephone interactions with patients. Up until the pandemic, that was just never done. It always felt like by the pairs they would say, if you call your patient after the visit then its bundled up. And now thats not the case. The reason i bring that up here is because for our patients that are in areas where they dont have broadband or for those patients that cant afford a tablet or smartphone. Theres been a lot of research to show that a lot can be done. Not everything. There are things that we miss if we dont have video especially as i alluded to in Mental Health. But theres a lot that can be done. My case, if you send me images, im perfectly comfortable telephone is an anchor point to solving that problem. Of course, we would love it, ata is me speaking as an official we would love if there was more broadband, if there was stimulus funds to create more penetration, not just for health care, but for all kinds of things. More broadband would be great. Telephone visits are good. Finally, making one of the things we own is, making these interactions more patientfriendly. God knows some of the software is hard. Some people have trouble downloading an app, et cetera. We have to find ways to make it easy. There is one telemedicine that platform that has the workflow that you send the patient a text message when you are ready for the visit. They click on the text and it open the video and they are chatting with you. We have to find it ways to make it easy like that. Host at the beginning of the discussion you mentioned hippa has gone out the window. Could you expand on that . Dr. Kvedar yes, sorry, i didnt actually mean it that way. For the pandemic, the federal government relaxed to the requirements that your video platform had to be hippa compliant. So we can use any number of things, and doctors didnt have to before, to get something and you had to hire an eye to consultant and hire an i. T. Consultant and do an rfp and we made it difficult. It is a great setting because we care so much about patient privacy and take it seriously. But if you are in practice with two or doctors and had to go three through that before it was an excuse not to get involved. The federal government, in their wisdom, was trying to let people overcome that at a time when the only way we could provide care to you was to do this by telehealth. As we see the pandemic start to wane and we get back to some level of in person care, i think we will probably see they will reinstate hippa. And i think that is a good thing, because for vendors to supply us with videoconferencing and other types of Patient Engagement technologies, they should be willing to hold your information as a patient secure. That should be part of their bargain and they should be able to do that. If they cannot do that we probably should not use their technology. Kimberly how can patients be confident their Health Information, over a Video Conference or over the phone, can be confidential. I think of instances where, perhaps, a physician might take a call from a patient at a public place like a Grocery Store . Or if the information were to get hacked as a patient is having a conversation. How can we make sure patients can feel comfortable and know that their Health Information is secure and will not be leaked for everyone to see . Dr. Kvedar sure, i am glad you brought it up because everyone is concerned about that and we certainly concerned about that at ata. Number one, it turns out that even though we allow these various nonhippacompliant platforms, most are secure. So for instance, skype is very secure. Whatsapp is very secure. Them are very secure. I think the likelihood, and this is important for patients, people watching this, the likelihood that you would get your information compromised during a video call is infinitesimally low. It is very small. Could it happen, yes. It is very unlikely, so that is one thing. And again, as we move forward, we will get back to a state of normalcy where we are demanding those technologies are secure before we use them. So we are headed in that direction again, i am sure. With regard to your question about the clinician, making sure the clinician is in a private place, we are training people as fast as we can. One of the activities im involved with is the association of american medical colleges, creating training competencies for residents and medical students to teach them a number of things about being a good teleheath provider. One of them is keeping your video chat private from the point of view of where you have it. So we are getting that word out as fast as we can. There arent too many people who are foolish enough to take it in the car or a public place so we are pretty well on the way to that. Are you getting resistance from physicians at all . Surprisingly, maybe little. I dont know if it is surprising you get into a Public Health emergency like this and peoples true stripes come out and everyone really , use whateverrty analogy you like, and participated, so very little resistance. Honestly, if you were to ask this in january, i would have and there would be more there wasnt because i think people fundamentally want to take care of our patients and that is our calling as clinicians. Very little. There are some specialties where they need the procedure or a piece of equipment and they just cant so for them, that is not resistance, that is just quality of care. Shouldy postpandemic, telehealth visits be paid as much as in person visits . Dr. Kvedar it is a complicated answer, and very highly nuanced, actually. I will try to break it down without sounding too nerdy. Innician compensation comes three buckets. Timeexity of thinking, spent with a patient, and practice expand. Ofwould argue the complexity thinking and time spent is what it is no matter what vehicle we are using to care for you and those should be compensated the same way. And this has not been proven yet at all, but it is possible when we scale telehealth, well find the practice expense may be less and that may be a way to differentiate payment. What the specific or official , the federal government, yes. We believe these things should be compensated at parity. We also recognize in private health plans will inevitably want to negotiate with payers, as they always do. We dont feel it is our place to get in the way of that. Kimberly we heard from a lot of Health Insurers when telehealth became more prominent toward the beginning of the pandemic. A lot of them said they would provide telehealth at no copay to patients. Patients whofrom have gotten Surprise Medical Bills from telehealth visits. They understood them to be included in benefits and ended up with a surprise bill. How do you prevent Something Like that and make sure patients know exactly what their benefits are supposed to cover . Allkvedar we would probably benefit from more transparency and simplicity in our industry. It. S face it is convoluted and it is difficult sometimes to communicate the nuances of various plans and various to plan determination members, and i would say during really making not an excuse for anyone, but i would say we have thrown a lot colleaguesth plan and said please pay for all of this. The are waiting throughout best they can, so it is a longwinded way of saying id and any memberk, has the opportunity to go back and question any of that, right . We all do, but it has been a tough time for everyone and they are weeding through eight in a careful way so some of those things may have slipped through the cracks. Kimberly so it sounds like you think it is more about speed bumps than any particular dr. Kvedar i do. This is another thing i wouldnt have predicted that ive talked to a lot of health plans. Not universally, but a lot of them are on board with continuing this. Belief, it is only a belief i shouldnt say that, because there is some data to support it, but if we can keep people healthy in their home, we can lower cost by keeping people out of the emergency room. If we do it right, well save premium dollars. Isdr. Joseph kvedar president of the american telemedicine association, a Harvard Medical School professor and practicing dermatologist. Kimberly lenard covers health care for Business Insider. Is there a chance these sessions recorded, thusbe increasing the privacy concerns . Now, as we arel, currently doing this and a looted to earlier, there are tople using alluded earlier, people are using every platform and part of that is being able to use the record button. To do thatmake sense unless you are recording part of a neurology exam for part of the record, and patients will have the option of doing that, as well. I dont think that should be part of our future, but right now, it is what happe