New Trend or Passing Fad?
Telehealth Services

^{This blog is the SECOND in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.}

Thanks to the COVID-19 pandemic, social distancing and stay-at-home orders during the past two months have made it difficult to have a face-to-face meeting with our doctor(s).

But necessity is indeed the mother of invention, and thankfully, telehealth – using email, video conferencing, online patient portals and other technologies – was already being used by some providers to aid in the delivery of patient care, typically to the benefit of rural patients.

Telehealth has been around for quite some time – at least a few decades. But its relatively steady growth trajectory has been refueled by the COVID-19 virus, prompting enhanced usage that we have not seen before. Patients, both young and old, have found a new method to safely seek care. Cleveland Clinic, as one example, has reported that demand for virtual visits is up more than 1,000 percent since the start of the pandemic.

For the sake of simplicity, I will be using the term telehealth interchangeably with telemedicine. According to HealthIT.gov, telehealth is different from the term, telemedicine, “because it refers to a broader scope of remote healthcare services than telemedicine.” Telemedicine refers to remote clinical services, while telehealth goes beyond clinical services to also include non-clinical services, such as provider training, administrative meetings and continuing medical education. Any reference to telehealth, therefore, also includes telemedicine.

Prior to the pandemic, telehealth usage wasn’t widely adopted in healthcare for many reasons. To understand the push-pull of telehealth, we must first understand the perspectives from patients and their healthcare providers.

Patient Perspective

For patients, telehealth can provide value and benefits for many key reasons, including:

1. Less time in the doctor’s waiting room.
2. No need to take time off of work.
3. No transportation time or parking hassles.
4. Reduced risk of obtaining infection while at doctor’s office.
5. Eliminate child or elder care issues.
6. More affordable.
7. Access to specialists.

Telehealth, it must be noted, is not the panacea for every health-related scenario. A medical emergency or a difficult case to diagnose will still require a visit to the doctor or hospital. Telehealth can include physical exams, but depending on procedures performed (e.g. blood drawing, biopsy, X-ray, strep test) the process is more limited. But for wellness-related interactions, such as common office visits and mental health consultations, telehealth can be an efficient interaction process. A sample telehealth consent form offered up by the Agency for Healthcare Research and Quality provides easy-to-understand insight for patients who pursue telehealth services.

Physician Perspective

Physicians and hospitals, on the other hand, are a different story – at least prior to the pandemic. Generally, in the pre-COVID past, providers did not receive higher pay when using telehealth care, and most of the time, they received less pay for telehealth care when compared to in-office care.

With telehealth services, doctors would have to do essentially the same amount of work regarding time spent with the patient and documentation requirements, all while learning a new workflow to interact and treat patients. For this, the doctor is paid less for their time – something that few of us would want to experience in our own jobs.

Telehealth usage prior to the pandemic, therefore, struggled to quickly trend upward largely due to lack of payment parity with face-to-face office meetings. Without payment parity, telehealth did not see the growth gains that it currently has found under the current pandemic environment.

The value equation must also work for the health provider as it does for the patient.

Telehealth and the COVID-19 ‘Experiment’

With the advent of the virus epidemic, telehealth became an overnight ‘sensation’ for a few key reasons. To help providers experience telehealth as a value equation, Medicare is now paying for most visits and many private payers* waive virtual visit copayments, including Wellmark in Iowa. As of March 6, Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

^{*Some insurers have subsequently found, due to software problems, they are unable to immediately eliminate telehealth copays and cost sharing for millions of members. Additionally, carriers need consent from their self-insured clients to implement these policies.}

Many states have relaxed, or deregulated, more stringent requirements for telehealth usage, including Iowa.  The Federation of State Medical Boards provides an updated listing of all states and their telehealth practices regarding COVID-19.

Stay-at-home orders offered legal risks if doctor offices and clinics stayed open and did not adopt telehealth services. Avoidance of legal risks and in-office infection, coupled with payment parity has made telehealth a tool for many health providers to finally embrace.

Going Forward

The value equation for both patients and doctors will be interesting to watch. When the virus finally simmers down and social distancing requirements are greatly relaxed, how will doctors react when their patients can safely return to visiting the doctor? Will the value equation for the doctor shrink from the heightened COVID period or will doctors look more long term on valuing physical distance for their own health, including staff members, and accept telehealth in the future?

Now that the genie is out of the bottle, will patients demand more telehealth services? Perhaps the patient experience during the COVID period will push patients to seek telehealth services elsewhere should their doctor reduce or eliminate the telehealth options in place during the pandemic.

How telehealth services are reimbursed from payers will certainly predict the future for telehealth. Will telehealth reimbursement to providers become more marginalized whereby payment parity is no longer being practiced by key payers? Perhaps payment parity becomes more prominent and, as a result, unleashes additional sophisticated telehealth services than what is provided today? Clearly, the opportunities are just as great as the barriers. The barriers can be difficult to accessing telehealth, such as absence of technology, digital literacy and reliable internet coverage.

The future of telehealth services looks extremely bright, but it will largely be dependent on how physicians view the value proposition of delivering this service to their patients. The COVID-19 pandemic may have provided the fortuitous nudge for telehealth to become a mainstream model of delivering healthcare to Americans. This will be a trend worth following!

Next Week’s Discussion:  Reliance on Drugs from Foreign Countries

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