If you’ve seen your primary-care doctor since February, maybe you experienced telemedicine for the first time, too. If so, how did it go?
Health systems’ imperative to focus on COVID-19 also forced them to make virtual care available to the rest of their patient populations. Hospitals and clinics everywhere scrambled to expand technologies and to train caregivers to conduct and document virtual visits.
This immense effort created an opportunity that has met with massive public interest. In the Seattle-based health system where I direct telemedicine, we mushroomed from 200 virtual visits in February to more than 30,000 in April. If you had told me a year ago that we’d scale up like that, I would’ve been incredulous.
Similar reports have emerged across the United States. Among fee-for-service Medicare beneficiaries, for instance, telemedicine visits exploded from about 13,000 before COVID-19 to 1.7 million in the last week of April.
Despite making its debut under duress, telemedicine seems to have clearly communicated its benefits to patients: access and convenience.
But some stakeholders on the reimbursement side are starting to voice caution and raise flags of doubt about extending policies put in place as COVID-19 took hold. Made at the government’s behest, those policies reimburse clinicians for telehealth visits at the same rate as in-person visits.
More recently, the Center for Medicare and Medicaid Services has proposed ending key provisions that enabled telemedicine to flourish during the COVID-19 pandemic.
It is not unusual to face skepticism and reluctance from organizations that reimburse for care. Before coronavirus, Medicare restrictively required a telemedicine visit to meet two onerous criteria: Patients had to live in a designated “rural” or “medically underserved” area — which in Washington state omitted 80% of residents — and, incredibly, patients could not be in their own homes for the visit.
Private insurers also have mostly resisted opportunities to support telemedicine. For the decade-plus that the technology has existed, insurers have challenged telemedicine’s effectiveness. They’ve often portrayed virtual care as a costly enticement to patients who ultimately will need to see a doctor in person.
In my experience, that scenario is exceedingly rare. It is avoided by educating patients and providers about what conditions are appropriate and what care can be legitimately delivered in a telemedicine visit.
It is true that we have to study telemedicine, now that it is delivered on a grander scale than ever. Is the cost of virtual care greater overall? If costs are greater, are they reasonable, given our focus on value-based care? What technology hurdles persist for patients? Are physicians conducting and documenting virtual visits as well as those done in-person?
Health care systems are putting quality-assurance regimens in place to better understand all these questions. But the efficacy of digitally based care is well established. Small-scale rollouts over the past 15 years have repeatedly shown that telehealth-based patient outcomes are equal or superior to in-person care: in ophthalmology, cardiology, psychiatry, dermatology and orthopedics, among others.
Obviously, telemedicine has limited value with care that depends on a physical exam or procedure. We aren’t able (yet) to do a detailed abdominal exam by telemedicine. In those cases, in-person care is best.
But primary care can be effectively delivered virtually in many cases, we’ve learned. Moreover, the capability has been a lifeline for people who struggle with mobility or rely on public transportation or care for young children during the day.
Consider one population newly thriving with telemedicine: pregnant women. If pre-supplied with a blood pressure cuff and portable Doppler ultrasound, and shown how they are used, these women can get 50% of their prenatal care via TeleOB. In feedback, we’ve consistently heard patients express appreciation for not having to get in the car, fight traffic and find parking for a 10-minute checkup they can now have at home.
Only Congress has the authority to make lasting changes to Medicare policy. Bills to permanently enact telemedicine policy changes have been introduced in the U.S. House and Senate. We encourage federal lawmakers to back these bills.
The difference will be in the details. If legislation ensures that health care providers are reimbursed equally for virtual and in-person care, perhaps in another decade telehealth will be as comfortable and desirable as online banking is today.