Last month, I heard the disappointing news that the Center for Medicare/Medicaid Services plans on ending reimbursement for virtual visits by December 31, 2024 for all medical appointments other than in rural locations or for mental health. Ironically, I was attending a meeting virtually when this announcement came through. The proposal was somehow tied to the expiration of the public health emergency, but in my view, the two are unrelated, and this is a terrible idea with negative implications for patients and providers alike.
The pivot to virtual care was not easy, especially for many older and not-so-tech savvy patients (and doctors!!); however, as with any change there was a learning curve, and quickly we found out that virtual visits worked well for many things. They are particularly effective to follow chronic medical conditions, such as hypertension or diabetes, when we have access to data such as a glucose monitor or a home blood pressure cuff. I can order the necessary labs, make medication adjustments, and provide diet and exercise advice with the same outcome as if the patient were sitting in front of me in the exam room. In fact, it was easier to arrange more frequent follow up for patients that needed it, since they didn’t need to drive across town to the clinic particularly in the winter months. One can argue that a very good reason to continue virtual care has to do with health equity and improving outcomes for patients who have difficulties with transportation, or, given their work schedule cannot take three hours off to attend a 30 minute in person appointment.
From a wellness perspective, I wanted to keep my Monday clinic virtual because of the flexibility, autonomy, and efficiency it provided. I decided when the session would begin and end, picking a time that worked with my schedule rather than conform to clinic start and stop times. I can choose to drive to my office and perform virtual visits at work, or, stay at home and utilize my home office which saves commute time. Even the ability to run a load of laundry while working from home is a huge advantage to a busy full time physician with two kids. And while seeing each patient via video, I was typing my notes and orders as we were talking, which saved time and improved efficiency. I would end my block of virtual clinic with all my notes signed and encounters closed, while in person that adds a half hour or more to the end of the session. And I still had three days of in person clinic per week, which to me felt like the right balance. I might add that my clinic was able to hire two more MDs and one NP since 2020 because we were not as limited by the availability of exam room space. This improved access to both in person and virtual appointments to better serve our patients.
I find this notion of ending virtual care especially frustrating in light of the fact that almost every other industry allows their employees to work in a hybrid mode; recent survey data quotes 58% of respondents were working remotely at least one day per week. My brother, working in finance, is almost 100% remote and absolutely loves it. In health care we are asking for 10-20% of our appointments to stay virtual, and now it appears even that is in jeopardy, based on archaic rules that do not allow reimbursement unless you are face to face with the patient. All of this on top of rising burnout rates and increased workload due to the pandemic—it truly feels like adding insult to injury. Would it cause many to consider cutting back on their practice or even early retirement? Most of my colleagues feel virtual care was the one and only positive thing to come out of the pandemic; why take it away?
I am writing this to urge all of us, patients and clinicians alike, to contact our governing bodies, leaders, and professional organizations to voice opposition to this decision. Contact your insurance company and ask them to continue to provide coverage for virtual care. Because although the CMS decision only affects Medicare and Medicaid recipients, private insurance carriers tend to follow suit. We must, over the coming months, advocate for virtual care to stay a part of healthcare permanently. Let’s not lose this opportunity to expand access to services and provide much needed flexibility to health care providers, encouraging them to continue to practice in an era of ongoing shortages. My patients have expressed much gratitude and appreciation for having virtual care available to them; I hope to honor that and I will be a strong advocate for continuing this option.
Welcome to Doctor Heather 