Manufofin Telehealth sunyi rikitarwa a cikin 2020
Idan ka fada min a farkon shekarar da ta gabata cewa jimillar kudin shigar da Amurka ke samu a duk shekara zai karu daga kimanin dala biliyan 3 zuwa dala biliyan 250 a 2020, ina tsammanin zan iya tambaya cewa an bincika kanku, kuma ban yi hakan ba yana nufin kan bidiyo! Amma tare da cutar ta COVID-19, mun ga tasirin telehealth daga kasancewa zaɓi na sabis na kiwon lafiya na ƙasa zuwa zaɓi mafi kyau ga miliyoyin Amurkawa don karɓar kulawarsu a wannan lokacin ƙalubale. Telehealth ta ba da izinin ci gaba da kiwon lafiya a yayin annobar, kuma telehealth ta kuma fadada ta hanyoyi daban-daban don sauƙaƙa wa mutane karɓar sabis na musamman kamar lafiyar halayyar mutum, ba tare da buƙatar ziyarci ofishin likita ba. Kodayake telehealth ta kasance shekaru da yawa, don a ce wajan tarwatsewa cikin hasken ƙasa a cikin 2020 ba zai zama abin faɗi ba.
A matsayina na wanda ya kasance cikin harkar sadarwa tsawon shekaru hudu da suka gabata, nayi matukar mamakin yadda yanayin layin telehealth ya canza a wannan shekara, da kuma yadda ya zama mai rikitarwa. Tare da farawar COVID-19, tsarin kulawa da kiwon lafiya da ayyukanda suka cika cikin 'yan kwanaki abin da akasin haka zai ɗauki makonni, watanni, ko ma shekaru, kamar yadda aka horar da dubban ma'aikatan kiwon lafiya da masu gudanarwa kan aiwatar da wayar tarho da ƙirƙirar da koyon sabbin ayyuka. , ladabi, da gudanawar aiki don tallafawa tallafi na telehealth da sauri-sauri. Wannan aiki mai wahala an biya shi yayin da CDC ta ba da rahoton cewa ziyarar telehealth ta karu da 154% a cikin makon da ya gabata na Maris 2020, idan aka kwatanta da daidai wannan lokacin a cikin 2019. A watan Afrilu, ziyarar kai tsaye zuwa ofisoshin likita da sauran ayyukan kiwon lafiya sun faɗi 60%, yayin ziyarar telehealth sun kai kusan kashi 69% na jimlar matsalolin kiwon lafiya. Masu ba da kiwon lafiya suna kawo kusan sau 50-175 fiye da ziyarar telehealth fiye da waɗanda suka yi kafin-COVID-19. Ee, “sabon abu na yau da kullun” na telehealth hakika yana nan, amma menene ainihin ma'anar wannan?
To, yana da rikitarwa. Bari in yi bayani. Babban dalilin da ya sa telehealth ta iya zuwa gaban aikin bayar da kiwon lafiya a wannan shekarar ba lallai ba ne saboda cutar COVID-19 kanta, amma a maimakon hakan ya kasance ne saboda sauye-sauyen manufofin telehealth da suka zo a sakamakon cutar. A baya a watan Maris, lokacin da aka fara ayyana dokar ta-baci ta kasa, an ba da karin sassauci ga hukumomin tarayya da na jihohi don magance rikicin, kuma sun yi hakan. Cibiyoyin Medicare da Medicaid Services (CMS) sun faɗaɗa fa'idodin aikin na Medicare na telehealth, a karo na farko suna ba masu cin gajiyar Medicare damar karɓar sabis da yawa ta hanyar bidiyo da waya, suna taɓar da bukatar dangantakar da ta gabata, da kuma ba da damar karɓar sabis na layin kai tsaye a gidan mara lafiya. Har ila yau, Medicare ta bayyana cewa masu samarwa za su iya yin lissafin kuɗi don ziyarar telehealth daidai gwargwadon ziyarar mutum, wanda aka fi sani da telehealth Hakanan a cikin Maris, Ofishin 'Yancin Dan Adam (OCR) ya sassauta manufofinta na tilasta aiwatarwa kuma ya ce zai yi watsi da yiwuwar hukunta HIPAA idan ana amfani da aikace-aikacen bidiyo da ba sa jituwa a baya, kamar FaceTime da Skype, don sadar da telehealth. Tabbas, akwai wasu sauye-sauye da yawa game da manufofin telehealth da aka aiwatar a matakin tarayya, hanya da yawa da zamu lissafa anan, amma wasu daga cikin waɗannan, tare da wasu canje-canjen da muka bincika yanzu, na ɗan lokaci ne kuma suna da alaƙa da gaggawa ta lafiyar jama'a (PHE ). Kwanan nan CMS ta buga kwaskwarimar su ta 2021 zuwa Jadawalin Kudin Kwararrun Likitoci (PFS), suna yin wasu canje-canje na ɗan lokaci na dindindin, amma har yanzu akwai sabis ɗin da aka saita don ƙare a ƙarshen shekarar da ƙarshen PHE ya ƙare. Dubi abin da nake nufi? Mai rikitarwa.
Na ƙi in rikitar da abubuwa har ma fiye da haka, amma yayin da muke tattaunawa game da sauye-sauyen manufofin telehealth a matakin jiha, ina jin tsoron hakan na iya zama makawa. Ofaya daga cikin abubuwan da suka fi ban sha'awa, da takaici, game da wayar tarho shine cewa an ayyana shi kuma an tsara shi daban-daban a kowace jiha. Wannan yana nufin cewa, a matakin jiha, kuma musamman ga yawan Medicaid, manufofin telehealth da biyan kudi sun banbanta, kuma ire-iren ayyukan sadarwar da aka rufe na iya bambanta sosai daga wannan jihar zuwa wancan. Colorado ta kasance kan gaba wajen yin wasu daga cikin waɗannan sauye-sauye na manufofin telehealth na dindindin kamar yadda Gwamna Polis ya sanya hannu kan dokar Majalisar Dattijai 20-212 a cikin doka a ranar 6 ga Yulin, 2020. Kudirin ya hana Raba Inshorar-tsarin kiwon lafiya daga:
- Sanya takamaiman buƙatu ko iyakance akan fasahar da ta dace da HIPAA da ake amfani da ita don isar da sabis na gidan waya.
- Bukatar mutum ya sami kyakkyawar dangantaka da mai ba da sabis don karɓar sabis na wayar tarho da ke da mahimmanci daga wannan mai ba da sabis.
- Atingaddamar da ƙarin takaddun shaida, wuri, ko buƙatun horo azaman yanayin biyan kuɗaɗen sabis na wayar tarho.
Don Shirin Medicaid na Colorado, Majalisar Dattijai ta 20-212, ta sanya wasu mahimman manufofi na dindindin. Na farko, yana buƙatar ma'aikatar jihar ta sake biyan asibitocin kiwon lafiya na karkara, da Hukumar Kula da Kiwan Lafiya ta Tarayya, da Cibiyoyin Kiwan Lafiya na Tarayya don sabis na telehealth da aka ba wa masu karɓar Medicaid daidai da lokacin da aka ba da waɗannan sabis ɗin a cikin mutum. Wannan babban canji ne ga Medicaid na Colorado, kamar yadda kafin annobar ta faru, ba a sake biyan waɗannan abubuwan ba don samar da sabis na telehealth. Na biyu, lissafin ya fayyace cewa kula da lafiya da kuma kula da lafiyar hankali a cikin Colorado na iya hada da maganin magana, maganin jiki, maganin aiki, kula da asibiti, kula da lafiyar gida, da kula da halayyar yara. Idan ba a zartar da wannan kudurin ba, da wadannan fannoni ba su sani ba ko za su ci gaba da ba da kulawarsu ta wayar salula lokacin da annobar ta kare.
Da kyau, mun tattauna game da wasu canje-canje na manufofin telehealth na ƙasa da na ƙasa, amma yaya game da manufofin telehealth don masu biyan kuɗi, kamar Aetna da Cigna? Da kyau, a halin yanzu, akwai jihohi 43 da Washington DC waɗanda ke da dokokin biyan kuɗi na biyan kuɗi na telehealth, wanda ya kamata ya nuna cewa a cikin waɗannan jihohin, wanda ya haɗa da Colorado, ana buƙatar masu inshora su mayar da kuɗin telehealth daidai gwargwado kamar na kulawa cikin-mutum , kuma waɗannan dokokin suna buƙatar daidaito don telehealth a cikin ɗaukar hoto da sabis. Duk da yake wannan ba shi da rikitarwa, Na karanta wasu kaɗan daga waɗannan dokokin daidaitattun jihohi kuma wasu daga cikin yaren ba su da ma'ana yana ba wa masu biya masu zaman kansu damar ƙirƙirar nasu, mai yiwuwa ya fi ƙarancin manufofin telehealth. Shirye-shiryen masu biyan masu zaman kansu suma dogaro ne da manufofin, ma'ana suna iya ware telehealth don biyan kuɗi a ƙarƙashin wasu manufofin. Ainihin, manufofin telehealth don masu biyan masu zaman kansu ya dogara da mai biyan, jihar, da takamaiman manufar shirin kiwon lafiya. I, rikitarwa.
Menene ma'anar wannan duka don makomar telehealth? Da kyau, asali, zamu gani. Tabbas da alama telehealth zata ci gaba da faɗaɗa cikin amfani da farin jini, koda bayan annoba. Wani binciken McKinsey na baya-bayan nan ya gano cewa kashi 74% na masu amfani da layin telehealth a yayin annobar sun ba da rahoton gamsuwa sosai da kulawar da aka ba su, yana mai nuna cewa mai yiwuwa ne a ce aiyukan sadarwar na iya tsayawa a nan. Hukumomin majalisun dokokin kiwon lafiya na kasa da kowace jiha zasu bukaci yin nazarin manufofin su na telehealth yayin da karshen PHE ke gabatowa, kuma dole ne su tantance wadanne manufofin zasu ci gaba da kuma wadanne ya kamata a canza ko a dakatar dasu.
Tunda telehealth tana buƙatar marasa lafiya su sami damar yin amfani da fasaha da intanet, gami da wani matakin ilimin ilimin fasaha, ɗayan abubuwan da kuma yakamata a magance su shine "rabe-raben dijital," wanda rashin dacewar mutane Black da Latinx, tsofaffi, mazaunan karkara, da mutanen da ke iyakantaccen ƙwarewar Ingilishi. Yawancin mutane a Amurka har yanzu ba su da damar yin amfani da wayoyin komai da ruwanka, kwamfuta, kwamfutar hannu, ko intanet na intanet, kuma har ma da ɗaruruwan miliyoyin daloli da aka ware don rage waɗannan bambance-bambancen ba zai isa su shawo kan yawancin shingayen tsarin ba hakan na iya kawo cikas ga irin wannan ci gaban. Ga dukkan Amurkawa don samun damar yin amfani da telehealth da kuma cin gajiyar duk ayyukanta a yayin da bayan ƙarshen annobar za su buƙaci ƙoƙari mai ƙarfi a matakin jihohi da tarayya don ƙayyade haɗuwa da ayyukan gudanarwa da na dokoki da ake buƙata don yin hakan. Yanzu wannan ba ya da rikitarwa sosai, shin?
Ina muku fatan alheri!
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0123
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771
Cibiyar Hadin Kan Manufofin Kiwon Lafiya: https://www.cchpca.org
https://www.healthcareitnews.com/blog/telehealth-one-size-wont-fit-all