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Keith Loria is a contributing writer to Medical Economics.
The first of a two-part story on 10 takeaways about the telehealth boom. The COVID-19 pandemic has been a bumpy ride in the U.S., featuring one controversy after another. One of the few areas of agreement is that the widespread adoption of telehealth amid the pandemic has been, by and large, a positive development.
The COVID-19 pandemic has been a bumpy ride in the United States, featuring one controversy after another. One of the few areas of agreement is that the widespread adoption of telehealth amid the pandemic has been, by and large, a positive development.
Here are the first 5 takeaways about the telehealth boom.
1. It wouldn’t have happened without CMS loosening its rules and paying for it
Earlier this year, CMS enacted new rules to provide practices with the flexibility to use telehealth solutions in response to COVID-19. They included providing payment parity for telehealth visits, allowing payment for many codes that were previously considered nonpayable, and the willingness of the federal Office for Civil Rights to waive enforcement of the HIPAA privacy rules allowing the use of non-HIPAA compliant technologies like FaceTime and Zoom to conduct visits.
“The COVID-19 pandemic led to a quantum leap in moving telehealth forward, almost overnight,” says Ronald Hirsch, M.D., FACP, vice president of regulations and education for physician advisory solutions at R1 RCM, a revenue cycle management company in Chicago. “However, this would not have happened without the regulatory flexibilities provided by CMS and other payers.”
In October, CMS announced it will reimburse providers for 11 more telehealth services, bringing the total to more than 140. Its proposed 2021 Physician Fee Schedule also paves the way for greater use of telehealth and would make some changes permanent instead of being tied to the federal government’s January 31 declaration of a public health emergency.
Of course, there was telehealth before the pandemic. It was gaining a foothold in many areas of the healthcare system but it seemed stuck on the margins, particularly among large health systems on the East Coast.
“The slow adoption was largely due to the lack of reimbursement and payment parity when there was reimbursement all,” says Iris Berman, M.S.N., RN, vice president of telehealth services at Northwell Health, the 23-hospital health system in the New York metropolitan area. “Much of the reimbursement directed by CMS was to rural communities, which excluded many of our most vulnerable in urban population centers.”
2. There’s no going back partly because telehealth has become so popular
Peter Antall, M.D., chief medical officer of Amwell, a Google-backed telemedicine provider that went public in September, says the average monthly visit volume on his company’s platform increased by about 300% between April and June compared with the first three months of the year.
“Today telehealth is no longer a nice-to-have but rather seen as necessary part of the care journey, and we expect this momentum to largely continue post-pandemic,” Antall says. “Ultimately, you can’t put the toothpaste back in the tube. Now that both patients and providers have experienced the convenience of telehealth, we don’t anticipate healthcare to ever go back to how it was.”
Adoption and acceptance grew as both the public and the providers realized gains such as improved scheduling, reduced travel time, and easier access to specialists, which sometimes occurred in a matter of minutes or hours instead of days and weeks. “Time will tell what the future holds for telehealth but we won’t return to the baseline we were at before the pandemic,” says Natalie Pageler, M.D., M.Ed., chief medical information officer at Stanford Children’s Health and clinical professor of pediatric critical care at Stanford University. “Now that both patients and physicians have tried it and learned how to use it, they see the value and incentive to continue using virtual visits.”
Before the pandemic, Stanford Children’s Health was conducting about 20 telehealth visits per day in the ambulatory setting. Within a matter of weeks, that number grew to 700 to 800 per day. “In May, we began resuming care that had been delayed by COVID-19. But even now as our in-person visits are continuing to increase further, we’re still seeing almost the same number of telehealth visits,” Pageler says. “With the increase in awareness of the capabilities of telehealth and digital health, we are seeing many lessons learned from both the provider perspective as well as the patient/family perspective about the value of telehealth visits and the type of care that can be delivered via telehealth.”
George Valentine, a telehealth executive at Cox Communications, a regional telecommunications company headquartered in Atlanta, Georgia, shares the opinion that telehealth is winning the popularity contest. Valentine pointed to survey data collected by consulting company McKinsey & Co. that found that 74% of telehealth users reported high satisfaction, that 57% of providers view telehealth more favorably than they once did, and that 64% of providers are more comfortable using it now than ever.
3. Necessity is the mother of adoption
Once COVID-19 arrived, the slow-and-steady-wins-the-race pace turned into a sprint. Healthcare providers started working around the clock to start telehealth programs and improve connectivity. Part of the motivation was making up for revenue lost by the lack of office visits.
Forrester Research issued a report in October that made bullish predictions for telehealth next year. The report noted the sharp drop-off in primary care visits because of the COVID-19 pandemic and the rise of telehealth (and the health clinics inside retailers) to take their place.
“Primary care as we know it today stands in the crosshairs, with new entrants vying for the hearts of consumers who legacy healthcare ignored for too long,” said a Forrester blog post about the report.
4. This is your father’s telehealth
Millennials and their demographic successors in Generation Z have grown up in immersed in an online, digital environment. It has been a truism of telehealth that it would appeal most to younger people who are used to conducting so much of life remotely via their phones and other devices. But recent surveys have shown that age may be less of a factor in telehealth acceptance than many thought, and that those older than 65 have seen the value and convenience of using telehealth services.
“Used correctly, it is an adjunct to in-office visits that saves time in travel and can actually improve coordination of care,” Berman says. That could be especially important for older people because they are more likely to have multiple and complex health problems. In the past, people with complex medical problems would have to make separate trips to see, say, their pulmonologist, cardiologist and oncologist. Each of these visits required arranging transportation and carving out several hours out of the day. Telehealth will not replace the in-person visits if only because of the tests that must be done in person; the tele-MRI scan is not available yet. Still, with telehealth, it is conceivable that separate specialists could be convened for the same patient visit and the care coordination that is much talked about but realized much less often might actually occur.
About 80% of visits are about seeing and talking with patients, sometimes with significant others present, with no physical presence required, Berman notes. “Using telehealth for these types of visits affords more efficiency and less wait time in offices for the patient,” Berman says. “Provider quality of life can improve as well. All of this, of course, is with appropriate and well-planned use in conjunction with good workflows. We must think about telehealth as being a tool in the tool chest.”
5. But telehealth could be boon for pediatric care, too
Pediatrics requires some in-person care; a vaccine can’t be administered digitally. And typically children are not dealing with chronic conditions that require medication, tests and so on. Still, childhood is a period of relatively high use of healthcare services, some of which might improve with telehealth. Pageler says telehealth could be important for child health because it allows some services to be provided without disrupting school, sports, and other extracurricular schedules. Unless the condition warrants intensive hospital care or specific in-person procedures or exams, telehealth would allow physicians to see patients who require ongoing care for follow-up appointments, she says.
Keith Loria, a regular contributor to Managed Healthcare Executive®, is a healthcare writer in the Washington, D.C., area.