For many years, there has been talk about disruptive technologies in health care, such as telehealth, machine learning, and artificial intelligence. And an ever-increasing number of health care related apps are now being developed.
Telehealth, however, did not quite make it into the limelight and, more importantly, into our homes, until another rather unexpected disruption reared its head: COVID-19. The challenges that COVID-19 has imposed on our day-to-day lives have brought telehealth front and center for patients and physicians alike. Challenging times require us not just to adapt but to adapt quickly.
Beyond its role in every day medicine, telehealth plays an important role in disasters and public health emergencies. However, legal, regulatory, and reimbursement challenges have impeded its widespread use in the past. The slow adoption of this technology by physicians (and, by extension, patients) until recently can primarily be attributed to the following: a lack of medical licensure reciprocity among states, which would allow physicians licensed in one state to evaluate and treat patients in other states, different laws governing the practice of telemedicine in different states, and disparities in reimbursement and lack of payment parity for televisits compared with in-person visits.
Fast forward to March 2020, with mandatory lockdowns instituted across the U.S., and telehealth companies are seeing their visit numbers skyrocket. Physician practices have increasingly converted to televisits, with patients reluctant to venture out in violation of stay-at-home directives. A recent survey conducted by Merritt Hawkins showed that nearly half of all physicians are now using telehealth, a steep increase from 18% in 2018.
Recognizing the need for rapid incorporation of telehealth into physician practices, state and federal governments have mobilized resources and temporarily rolled back some regulations to facilitate the process. The CARES Act has appropriated $200 million for the Federal Communications Commission to support these efforts to address the COVID-19 pandemic. These funds are meant to give health care providers access to telecommunications services, information services, and devices necessary to enable the provision of telehealth services. Several states have granted temporary medical licensure waivers so physicians can provide care across state lines, and CMS has granted payment parity for telehealth visits, including for therapists and phone services.
As an internist who has practiced face-to-face medicine for over a decade and has been transitioning to telehealth over the last few months, I have welcomed the opportunity to continue providing care to patients during this pandemic. As expected, young patients have embraced telehealth more readily than older patients. That said, my most heartening encounters have been with elderly patients, seeing their absolute amazement at being able to access their physician from the comfort of their homes.
The convenience factor for the patient cannot be overstated: not having to take time off work or go through the hassle of driving to and from the doctor’s office. This in and of itself will likely sustain the popularity of telehealth well beyond the current health emergency. For physicians, telehealth provides the flexibility to check in on some of their sicker patients between regular visits as well as a more cost-effective way to deliver quality care to their patients with minor illnesses.
What happens when the rush of patients spurred by this pandemic slows down? Will COVID-19 permanently alter the telehealth landscape? Will the patients who sought televisits during the pandemic continue to use them? Will the government and private insurance companies continue to honor the flexibility in licensure and upgraded reimbursement of televisits?
My take on all this is that patients will continue to seek telehealth visits. In fact, it is quite likely that, in many cases, telehealth will become patients’ and physicians’ first choice when seeking or providing health care, pushing the government and private payers to step up to meet their demands. There will undoubtedly be an increased impetus to create legislation and reimbursement policies promoting telehealth.
Telehealth is here to stay. What years of raising venture capital, reporting on the benefits of telehealth, and lobbying Congress have failed to accomplish, the coronavirus has managed to achieve in mere months. The effects will last well beyond this pandemic.
Our next goal should be to focus on making telehealth accessible to everyone, including the elderly, those with limited computer literacy, and those living in digital deserts. Only then will this technological advancement reach its full potential.
Dr. Himangi Kaushal is a board-certified academic internist. She has served as the founding program director of internal medicine residency at Memorial Healthcare System and at Kendall Regional Hospital, and as associate program director at the University of Miami Palm Beach Campus. She currently practices telemedicine and is enrolled in the University of Miami’s Health Sector Management and Policy Executive Master in Business Administration program.
Illustration by Jennifer Bogartz