Ndondomeko ya Telehealth Yavutikira mu 2020
Mukadandiuza koyambirira kwa chaka chatha kuti ndalama zonse zapachaka zaku US zachuma zidzawonjezeka kuchokera pafupifupi $ 3 biliyoni mpaka $ 250 biliyoni mu 2020, ndikuganiza ndikadakufunsani kuti mutu wanu uwunikidwe, ndipo amatanthauza pa kanema! Koma ndi mliri wa COVID-19, tawona kuti telehealth ikuyenda kuchoka panjira yothandizira zaumoyo ndikukhala njira yabwino kwa mamiliyoni aku America kuti asamalire nthawi yovutayi. Telehealth yalola kupitiriza kwa chithandizo chamankhwala panthawi ya mliriwu, ndipo telehealth yawonjezekanso m'njira zosiyanasiyana kuti anthu athe kulandira chithandizo chapadera monga thanzi labwino, osafunikira kupita ku ofesi ya dokotala. Ngakhale telehealth yakhala ikuchitika kwazaka zambiri, kunena kuti telehealth yomwe idawonekera kwambiri mu 2020 sikungakhale kunyoza.
Monga munthu yemwe wakhala ali pantchito yokhudzana ndi zamankhwala kwazaka zinayi zapitazi, ndadabwitsidwa ndi momwe malo azachuma adasinthira chaka chino, komanso momwe zakhalira zovuta. Poyambira COVID-19, machitidwe azachipatala ndi machitidwe omwe adakwaniritsidwa m'masiku ochepa zomwe zikadatenga milungu, miyezi, kapenanso zaka, popeza madokotala ndi oyang'anira masauzande ambiri adaphunzitsidwa kukhazikitsa telehealth ndikupanga ndikuphunzira ntchito zatsopano , ma protocol, ndi magwiridwe antchito kuti athandizire kukhazikitsidwa kwa telehealth mwachangu momwe angathere. Ntchito yolimbayi idapindula pomwe CDC idanenanso kuti maulendo a telehealth adachulukitsa 154% sabata yatha ya Marichi 2020, poyerekeza ndi nthawi yomweyi mu 2019. Pofika Epulo, kuyendera m'masom'pamaso kumaofesi azachipatala ndi machitidwe ena azaumoyo adatsika 60%, pomwe maulendo a telehealth amakhala pafupifupi 69% yazithandizo zonse zazaumoyo. Othandizira azaumoyo akupereka maulendo opitilira 50-175 maulendo ochulukirapo kuposa omwe sanapange COVID-19. Inde, "zachilendo zatsopano" pa telehealth zilidi pano, koma kodi izi zikutanthauza chiyani kwenikweni?
Ndizovuta. Ndiloleni ndifotokoze. Chifukwa chachikulu chomwe telehealth idakwanitsira kupita patsogolo pantchito yopereka chithandizo chazaumoyo chaka chino sichinali chifukwa cha mliri wa COVID-19 womwewo, koma zidachitika chifukwa cha kusintha kwa mfundo zaumoyo zomwe zidabwera chifukwa cha mliriwu. Kubwerera mu Marichi, pomwe dziko ladzidzidzi lidalengezedwa koyamba, ufulu wina udaperekedwa kwa mabungwe aboma ndi boma kuti athane ndi vutoli, ndipo adachitadi. Centers for Medicare and Medicaid Services (CMS) idakulitsa kwambiri mwayi wa Medicare wa telehealth, kwa nthawi yoyamba kulola omwe adzapindule ndi Medicare kuti alandire ntchito zambiri kudzera pa kanema komanso foni, kusiya kufunika kwa ubale womwe udalipo kale, ndikulola kuti ntchito za telehealth zilandiridwe mwachindunji m'nyumba ya wodwala. Medicare idanenanso kuti opereka chithandizo atha kulipira ndalama zoyendera anthu akakhala pa telefoni pamlingo wofanana ndi wokaona anzawo, zomwe zimadziwika kuti "parity" ya telehealth. Komanso mu Marichi, Office for Civil Rights (OCR) idasinthiratu mfundo zake ndikukakamiza kuti ichotse zolakwa za HIPAA ngati mapulogalamu apakanema osagwirizana, monga FaceTime ndi Skype, adagwiritsidwa ntchito kupereka telehealth. Zachidziwikire, panali kusintha kwamalamulo ochulukirapo pamitengo yantchito, njira zochulukirapo zomwe sizingatchulidwe pano, koma zina mwa izi, limodzi ndi zina zomwe zasintha zomwe takambiranazi, ndizakanthawi ndipo zimangirizidwa ku ngozi zadzidzidzi zaumoyo wa anthu (PHE ). CMS posachedwapa idasindikiza zowunikira zawo za 2021 ku Physicians Fee schedule (PFS), ndikupanga zina zosintha kwakanthawi kosatha, komabe pali ntchito zomwe ziyenera kutha kumapeto kwa chaka PHE itha. Mukuwona zomwe ine ndikutanthauza? Zovuta.
Ndimadana nazo kupondereza zinthu kwambiri, koma tikamakambirana kusintha kwamalamulo azachuma m'boma, ndili ndi mantha kuti izi ndizosapeweka. Chimodzi mwazinthu zosangalatsa, komanso zokhumudwitsa, chokhudza telehealth ndikuti chimafotokozedwa ndikukhazikitsidwa mwalamulo mosiyanasiyana mdziko lililonse. Izi zikutanthauza kuti, pamaboma, makamaka kwa anthu a Medicaid, mfundo za telehealth ndi kubwezeredwa ndalama zimawoneka mosiyana, ndipo mitundu ya ma telehealth omwe amapezeka imatha kusiyanasiyana kuchokera kumayiko ena. Colorado yakhala ikutsogola pakupanga kusintha kwamalamulo osakhalitsa pantchito yantchito yantchito pomwe Governor Polis adasaina Senate Bill 20-212 kukhala lamulo pa Julayi 6, 2020. Lamuloli likuletsa magawano azaumoyo a Division of Insurance kuti:
- Kuyika zofunikira kapena zoperewera pa ukadaulo wovomerezeka wa HIPAA womwe umagwiritsidwa ntchito popereka chithandizo cha telehealth.
- Kufuna kuti munthu akhale ndiubwenzi wolimba ndi wothandizirayo kuti alandire chithandizo chamankhwala chofunikira kuchokera kwa wothandizirayo.
- Kulamula zowonjezera chitsimikiziro, malo, kapena zofunikira monga kubwezeredwa kwa ntchito za telehealth.
Pulogalamu ya Colorado Medicaid, Senate Bill 20-212, imapanga mfundo zingapo zofunika kuzikhalabe. Choyamba, pamafunika kuti dipatimenti yaboma ibwezeretse zipatala zam'midzi, Federal Indian Health Service, ndi Federally Qualified Health Centers pazantchito zamatelefoni zomwe zimaperekedwa kwa omwe amalandira a Medicaid pamlingo wofanana ndi momwe mautumikiwa amaperekedwera mwa iwo okha. Uku ndikusintha kwakukulu kwa Colorado Medicaid, monga mliriwo usanachitike, mabungwewa sanabwezeredwe ndi boma popereka chithandizo chamankhwala. Chachiwiri, biluyi imanena kuti chisamaliro chaumoyo ndi ntchito zamisala ku Colorado zitha kuphatikizira chithandizo chamalankhulidwe, chithandizo chamankhwala, chithandizo chantchito, chisamaliro cha odwala, chisamaliro chanyumba, komanso chisamaliro cha ana. Ngati ndalamazi sizinaperekedwe, izi sizikanatheka kudziwa ngati angapitilize kusamalira chisamaliro chawo pakakhala mliriwu.
Takambirana za kusintha kwamalamulo adziko lonse ndi maboma, koma nanga bwanji mfundo za telehealth kwa omwe amapereka payokha, monga Aetna ndi Cigna? Pakadali pano pali mayiko 43 ndi Washington DC omwe ali ndi malamulo olipira anthu omwe amalipira ndalama zolipirira payekha, zomwe zikuyenera kutanthauza kuti m'maiko awa, kuphatikiza Colorado, inshuwaransi akuyenera kubwezera telehealth pamlingo wofanana ndi chisamaliro cha-munthu , ndipo malamulowa amafunanso kuti pakhale mgwirizano wokhudzana ndi zamankhwala polipira ndi ntchito. Ngakhale izi zikuwoneka kuti ndizosavuta, ndawerenga zingapo mwa malamulowa ndipo zina mwazilankhulozi ndizosamveka bwino zimapatsa olipira payokha nzeru zodzipangira okha, mwina malamulo oletsa kwambiri zaumoyo. Ndondomeko za olipira payokha zimadaliranso mfundo, kutanthauza kuti atha kupatula ndalama zomwe zingabwezeredwe malinga ndi mfundo zina. Kwenikweni, mfundo za telehealth kwa omwe amapereka payokha zimadalira omwe amapereka, boma, ndi ndondomeko yazaumoyo. Eeh, zovuta.
Kodi izi zikutanthauza chiyani mtsogolo mwama TV? Chabwino, kwenikweni, tiwona. Zikuwoneka kuti telehealth ipitilizabe kukulira pakugwiritsidwa ntchito komanso kutchuka, ngakhale mliri utatha. Kafukufuku waposachedwa wa McKinsey adawonetsa kuti 74% ya omwe amagwiritsa ntchito telehealth panthawi ya mliriwu ati akusangalala kwambiri ndi chisamaliro chomwe adalandira, kuwonetsa kuti kufunikira kwa ntchito za telehealth ndikotheka kukhala pano. Mabungwe opanga malamulo azaumoyo mdziko lonse ndi boma lililonse adzafunika kuwunika njira zawo zantchito zamapeto pakutha kwa PHE, akuyenera kudziwa kuti ndi mfundo ziti zomwe zatsala ndi ziti zomwe ziyenera kusinthidwa kapena kuthetsedwa.
Popeza telehealth imafuna kuti odwala azitha kugwiritsa ntchito ukadaulo komanso intaneti, komanso luso lina laukadaulo, chimodzi mwazinthu zomwe zikufunikiranso kuthana ndi "kugawaniza kwama digito," komwe kumasokoneza anthu akuda ndi a Latinx, okalamba, anthu akumidzi, komanso anthu osadziwa bwino Chingerezi. Anthu ambiri ku America alibe mwayi wogwiritsa ntchito foni yam'manja, kompyuta, piritsi, kapena intaneti yapaintaneti, ndipo ngakhale madola mamiliyoni mazana omwe aperekedwa kuti athetse kusiyanaku mwina sangakhale okwanira kuthana ndi zopinga zambiri zomwe zidalipo zomwe zitha kulepheretsa kupita patsogolo. Kuti anthu onse aku America athe kupeza chithandizo chamankhwala komanso kupindula ndi ntchito zake zonse panthawi yamatendawa komanso pambuyo pake, pakufunika kuyesayesa kozama kuboma ndi kumayiko ena kuti adziwe momwe angayendetsere ndi kuwongolera malamulo. Tsopano izi sizikumveka zovuta, sichoncho?
Ndikukufunirani telehealth yabwino!
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0123
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771
Pakati pa Ndondomeko Yathanzi Yolumikizidwa: https://www.cchpca.org
https://www.healthcareitnews.com/blog/telehealth-one-size-wont-fit-all