While on vacation in Florida a few years ago, I woke up one day with a sinus infection. Even balmy tropical weather and fresh mangos off the tree couldn’t distract me from my stuffy nose and the relentless pressure behind my eyes. I didn’t want to spend hours tracking down and visiting a physician, so I decided to try something new. I downloaded a telehealth app, connected with a physician via video chat, and drove to pick up my prescription at the pharmacy—all within an hour. That day, I had a first-hand experience with this evolution in healthcare.
Over the last decade, as high-speed internet has become more commonplace, a growing number of clinics and apps have begun offering telehealth as a way to connect with patients. In fact, in a March survey by Sage Growth Partner and Black Book Market Research, 25 percent of consumers had used a telehealth service, and 59 percent said they’d be open to giving it a try. Despite growing interest, telehealth has faced obstacles, such as heavy government regulations aimed at preventing fraud.
But then the coronavirus pandemic happened. In March, as states began going into lockdown and the country went into varying levels of quarantine, almost overnight, telehealth became crucial. Through e-visits, people could seek treatment for a myriad of conditions without having to leave home and risk contracting or spreading Covid-19. In response to the need, the Trump administration took emergency measures to lift restrictions and offer expanded Medicare coverage of telehealth services. States also began lifting licensing restrictions that prohibited providers from practicing across state lines. The urgency of the pandemic has brought the government, healthcare providers, and patients together to solve the obstacles surrounding telehealth. Now that these barriers have been broken, will remote care become the new norm, even once the pandemic is over?
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Telehealth Takes Off
As might be expected, increased government coverage of telehealth precipitated a surge in Medicare e-visits over the past few months, from a few thousand per week to just over 1.3 million, according to Medicare claims data. The private healthcare sector has also seen huge growth. According to FAIR Health, a national database of private health care claim records, U.S. telehealth claim lines in March increased year over year from 0.17 percent in 2019 to 7.52 percent in 2020.
Despite only recently going mainstream, telehealth has been around for over a decade. Gonzalo Laje, M.D., director of Washington Behavioral Medicine Associates and clinical associate professor of psychiatry and behavioral sciences at the George Washington University in Washington, D.C., started seeing patients remotely more than ten years ago. “Back then, the video systems were not as good as today,” he said. “’Can you hear me?’ That was half of the conversation. We’ve come a long way.”
Before the pandemic, about 25 percent of Laje’s consultations took place online. However, come March, that number quickly rose to 100 percent. On top of moving all of his existing clients online, new patient inquiries doubled by the end of March. “I was generally working seven days a week,” he said. “March and April were very, very difficult months in terms of stress.”
Social isolation has manifested in increased rates of depression and anxiety in his patients across the board. “They can’t see their family many times. They’re not seeing the grandkids or even socializing as they used to,” he said. “Having the possibility of doing tele-appointments is extremely important for these individuals.”
Laje isn’t the only one who experienced a spike in telehealth inquiries. Bruce Hogan is the cofounder of SoftwarePundit, a software analysis platform for small businesses. Before the pandemic, Hogan said he’d seen modest growth in clients’ telehealth adoption, especially for mental health, driven mainly by better internet access. “Being able to see all the software companies that didn’t even offer telehealth yet rush to create solutions that could help meet that demand was pretty interesting,” said Hogan. “It created quite the whirlwind around telehealth.”
A Solved Problem: The Telehealth Learning Curve
One obstacle to telehealth has simply been that it confused people. Even for the tech savvy among us, making a telehealth appointment can unleash a series of nested questions. Do you call your doctor first? Do you download an app from the App Store? Which app is the best? Does telehealth work with insurance? Is it effective for your specific ailment? It’s no wonder it took a global pandemic to force us to find answers. And still, a lot remains unclear.
Laje uses Zoom to see his patients. The video chat app offers HIPAA-enabled plans and a steady connection. While many of his elderly clients used to balk at the idea of using the app, Laje said because of the pandemic, many are now using Zoom to stay in touch with their families or attend clubs with friends. “It was very natural to them and certainly not the population I was expecting to have this kind of seamless adjustment,” he said.
The Role of In-Person Care in Telehealth
It probably goes without saying, but there are limitations to what you can do via teleconsult. You can’t get surgery over video chat, after all. But research is starting to show that for many areas of care, from telepsychiatry to physical therapy to diagnosing infections, video consultations can work just as well.
Now that all his clients are used to Zoom, Laje says they may not want to go back to the office once the pandemic is over. However, some of his services, like testing and medical treatments, require being in person, and for that, he’ll keep in-person hours. Additionally, he said he likes to establish a rapport with new clients by seeing them face to face and picking up on nonverbal cues. Overall though, Laje is confident in the quality of care he provides online. He’s poured over a number of studies that have found telepsychiatry to deliver the same outcomes. “There was no difference,” he said. “People doing teleconsults versus people doing face to face—the outcomes were the same.”
Saving Time & Increasing Access to Healthcare
Another factor driving the telehealth trend is time savings. “If you have two jobs or kids at home and you can’t find time to drive across town and see someone, it cuts down the time and allows you to be more flexible with your schedule,” Hogan said.
In the Washington, D.C., area where Laje lives, the time savings can be dramatic. Appointments are often 25 minutes, he said, but it can easily take 45 minutes for each leg of the commute. “At that point, that’s two hours of your day,” he said.
And that assumes a patient has access to transportation and is able to leave home. “Think of a patient who has mobility issues,” said Laje. “What about somebody who doesn’t have a car or who can’t leave the house for multiple reasons or any reason for that matter? They could still get adequate psychiatric care, and they don’t have to leave the house.”
Telehealth also helps those of us who have limited access to specialists. “Maybe you have a rare issue that you need to talk to somebody about, and you’re in a rural area,” Hogan said. “For those types of people, it expands access to care.”
Insurance Coverage for Telehealth: It's Complicated
Back when I was on vacation in Florida, the telehealth app I used, called Doctor on Demand, charged a flat fee of $50 for my consultation. Using insurance wasn’t an option. While not a terrible price, the bill was still double my insurance copay.
Historically, insurance coverage of telehealth visits has been limited or nonexistent. However, as part of the government’s emergency measures in March, the Centers for Medicare & Medicaid Services began paying for online office and hospital visits the same way it would if you were there in person. Providers could also choose to reduce or waive copays and deductibles. The policy changes also allowed providers to use low-cost video chat platforms like FaceTime, Skype, and Zoom to conduct their visits. “Right now, all insurances are covering visits in a simple, straightforward way,” said Laje.
The government has made it clear that these policy changes are meant to be temporary, however. Laje says he’s worried that public and private insurance won’t be able to afford continued telehealth coverage, and that patients will suffer. “It’s a very difficult time where a lot of people have lost employment and therefore also have lost benefits,” said Laje. “The insurance companies are also struggling. I don’t think they’re going to look for ways to spend more money.” Nevertheless, he says it may be hard to roll back telehealth now that people are used to it. “I don’t know what’s going to happen, but my guess is it may be hard to get the genie back in the bottle,” he said.
How to See a Tele-Doctor
When I made my foray into telehealth, the app randomly connected me to a physician from its database. There are several teleclinic apps available that work the same way, such as Teladoc, Amwell, and MDLIVE. For my simple ailment, that worked just fine. But for a more pressing health concern, I’d prefer to have control over who I end up seeing. While these apps are one way to go, many clinics, and Laje himself, opt to offer their online services independently through HIPAA-compliant video chat apps like Zoom.
Laje said there’s a lack of quality control when you go through teleclinic apps. “You’re not going to get better care through telehealth if the provider is not a good provider,” he said. “My suggestion would be to get a referral from your primary care doctor or even from a friend. Find the provider first and then see whether they do telehealth or not.”
To see if insurance will cover your visit, Laje suggests calling your insurance provider or looking at your insurance panel to see a list of doctors that work with your provider (and just hope that the recommended doctor is on the list!).
Is Telehealth the Future?
The benefits of telehealth are becoming apparent to the public, and the coronavirus is spurring widespread adoption of this powerful tool. “It does catalyze that shift towards telehealth,” Hogan said. He said companies have rushed to offer telehealth services, individuals have become comfortable using it, and internet access has improved to the point that the experience is often seamless.
However, according to Hogan, between insurance coverage and research, there’s a lot to hash out before telehealth becomes the norm. “You have to have a lot of proof that these telehealth treatments are as effective as the in-person option,” he said. “Getting that level of comfort as an industry overall can take quite a bit of time.”
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