Has telehealth had its day? It depends on who you ask
Monday, September 28, 2020
According to some new studies, telehealth use has plummeted from its COVID-19 peak in April and May when the pandemic was in full swing and much of the economy was shuttered. However, some reports suggest that its use continues to soar.
Per Doximity, estimates are that more than 20% of all medical visits will be conducted via telemedicine in by the close of 2020. This would represent more than $29 billion worth of medical services. Such a growth trajectory could see telehealth reach upwards of $106 billion of the U.S. healthcare market by 2023.
Despite the possible carving out of virtual care from the traditional face-to-face models, significant issues remain. Primary among them is reimbursement for virtual services.
Will the federal government move to enact longer term reform that was adopted as part of the amplified response from the nation’s healthcare leaders during the height of the COVID-19 spread?
Time will tell. Some efforts from lawmakers and lobbyists have taken place.
In August, the Federal Communications Commission (FCC) unanimously approved $200 million in telehealth funding and, within the same month, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to expand telehealth permanently, suggesting that telemedicine has come into its own.
To better understand the evolving role of telemedicine, Doximity researchers examined three important aspects of its use as a clinical tool. First, they conducted a comprehensive inventory of patients’ changing attitudes towards, and their experience with, telemedicine as a replacement for in-person visits to the doctor’s office.
In mid-September, a new bill was introduced that would mandate payers to ensure that all telehealth services be covered if those services are also furnished in person. H.R. 8308 was introduced by U.S. Rep. Dean Phillips (D-Minn.) and attempts to determine how healthcare providers are reimbursed for their telehealth services.
Payers want to set reimbursement rates for telehealth services. Some states have pushed back on this and enacted legislation allowing payers to negotiate reimbursement rates with providers.
In Florida, the state committed $2 million to expanding telehealth services in schools. The money comes from CARES Act funding and will expand telehealth access to mental health services in schools in 18 counties where access to specialists is limited and broadband connectivity is low.
Tennessee lawmakers passed legislation that expands coverage for telehealth services earlier this summer, requiring payers to cover telehealth services as they would cover in-person care, and also requiring payers to cover remote patient monitoring services if that service is covered by Medicare, with payer and provider negotiating the amount of reimbursement.
The new law mandates reimbursement parity for telehealth services up until April 2022. It also allows licensed alcohol and drug abuse counselors and veterinarians to use telehealth to meet patient-provider relationship and standard of care guidelines — also up until April 2022.
It also relaxes the definition of an originating site for telehealth delivery, by characterizing it as “the location where a patient is located for telehealth services and that originates telehealth service to another qualified site, such as the office of a healthcare services provider, a hospital, a rural health clinic, or any other location deemed acceptable by the health insurance entity.”
Researchers and users of the technology say the benefits of the technology are obvious: ease-of-use, more flexibility, and reduction in cost of delivery.
Doximity also reviewed how physicians are using virtual care tools, and analyzed adoption data from its telemedicine feature set, which has grown in the first half of 2020 to more than 100,000 regular physician users.
It found high adoption of telemedicine among patients and physicians alike, “with strong evidence indicating that this shift represents a true change in how medicine is delivered in the U.S. Moreover, we anticipate that demand for telehealth service options will continue to grow quickly, and care providers may even find themselves competing to provide the best telemedicine experience.”
However, according to data from Epic, telemedicine visits made up just 21% of total encounters by mid-July, down from 69% in April. In other words, a significant drop in use occurred despite rosy pontifications from others.
CMS proposed making nine new telehealth codes permanent in its physician fee rule for 2021, along with 13 on a trial basis. But greenlighting the most meaningful changes requires congressional action.
Will patients continue to use the service? After COVID-19 settles, they may ditch virtual visits for in-person and human-connected visits. Vendors say the biggest hump was getting patients to try the service, and now that many have, they won't go back as telehealth becomes normalized.
Twenty-three percent of respondents in Doximity’s survey said they planned to use telehealth again once the pandemic ends. Only 28% of people said they thought virtual visits were the same or better quality to an in-office exam.
That is a problem for the technology until a tipping point is reached, or the pandemic forces people to continue using such services for their healthcare needs.
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