Is Telehealth Here to Stay?

For more than a decade telemedicine is considered to be the next big thing in healthcare. With over 70% of Americans saying that the healthcare system is in a state of crisis and constantly growing number of available virtual care services, telehealth appears to be a solution.[1]

Undoubtedly, this solution is far from perfect – there are still a lot of uncertainties revolving around it, its implementation, overall benefits, etc. However, whilst COVID-19 – the biggest healthcare crisis in modern history, is in its peak, patients and healthcare providers are looking for safer and more innovative ways to get to one another.

Through digital technology, people deliver and receive medical services and health education, despite not meeting each other in person. The pandemic is changing the traditional healthcare delivery methods in a way that has not been seen in generations.[2] Does that mean telehealth is becoming the new normal and is it here to stay?

Benefits – Why Telehealth? →

Increased access to healthcare
Improved health outcomes
Reduced patient costs
More convenience
Reduced no-show rates

Adoption Barriers →

Lack of awareness
Concerns about the ability to get proper treatment online
Lack of a common legislation
Reimbursement is commonly cited as a major barrier for telemedicine
Issues surrounding remote patient management
Requirements on consent procedures vary significantly between states

Telehealth During the COVID-19 Crisis →

Where to Now? →

Benefits – Why Telehealth?

Telehealth holds the promise to address some of the most pressing issues of the current healthcare system: access to care, cost effective delivery, and distribution of limited providers. [3] Industry experts put emphasis on several benefits that telehealth holds:

Increased access to healthcare – patients in remote areas can easily obtain clinical help. Telemedicine can also reach more patients despite the physician shortage problem by providing them with more easily accessible platform to communicate and treat patients. That would help physicians, regardless of being less in numbers, to connect with bigger pool of patients.[4] [5]
Improved health outcomes – technology can improve service delivery and treatment. Timely response might be problematic especially for people in the rural areas. Telehealth is said to tackle such issues because it enables patients to receive treatment without travelling long distances. Patients diagnosed and treated earlier often have improved health. [6] [7]
Reduced patient costs – healthcare costs have been increasing, driving patients to look for alternative care and treatment. With telehealth the doctor’s visit is one click away – cutting travel and time-off-work costs. The costs of unnecessary ER visits/stays, could be limited if the patients can have an online consultation first.[8]
More convenience – being a click away from a doctor brings a feeling of security that whenever one needs a consultation, he can get help quickly without visiting the hospital. In some rural areas patients have to drive hours to get to the closest medical center. Being able to avoid waiting for a consultation is also something that could be achieved via online appointments. Remote consultations and triage increase the safety of both patients and physicians, especially in times of pandemics. Therefore, it is not surprising that “quicker access to care” is being cited as the main advantage of telehealth services in a recent survey conducted by SYKES.[9]
Reduced no-show rates –Nebraska Children’s Hospital was struggling with no-shows. A case study on it concluded that through telehealth platform implementation, patients from rural areas received access to online consultations, thus improving the no-show rates by 50%. [10]

Adoption Barriers

Telemedicine sparks heated debates. While patients are becoming more active consumers and are seeking more affordable care options, implementing telehealth is still posing some challenges:

Lack of awareness – many US consumers are still not aware they can chat with their doctor over the phone or via video. Over 70% of patients might lack familiarity with telehealth opportunities and basic concepts. [11] Some are unsure whether their health insurance covers telehealth consultations and fear it can add-up as an additional expense. [12]
Concerns about the ability to get proper treatment online – misdiagnosis is a key concern with telemedicine. [13] People are skeptical that one can get the right treatment without physically visiting a doctor. Misdiagnosis also happens face-to-face, but online consultations might increase the risk. That goes hand in hand with another concern that is the lack of personal touch. 36% of respondents prefer a personal (face-to-face) engagement with their caregiver. 40% are concerned about the accuracy of a treatment or a diagnosis made in a virtual setting. [14]
Lack of a common legislation – with licensing, the laws vary depending on the state. It becomes more problematic now as there is a shift from operations within a single state to a multi-state system with multi-state practices, so moving into a national system might face serious challenges. [15]
Reimbursement is commonly cited as a major barrier for telemedicine – there is a lack of cost control. State and federal policies about reimbursing clinicians for providing care via telehealth continue to differ, hindering the service’s full potential. [16]
Issues surrounding remote patient management – RPM is an increasingly important method of health care delivery that enables a provider to remotely monitor vital signs and other biomarkers such as blood sugar or weight. However, Medicare does not consider remote patient management to be a type of telehealth, so physicians are not being reimbursed for it. [17]
Requirements on consent procedures vary significantly between states – Consent laws are vital for telehealth services, primarily due to the sensitivity of the patients’ private data. However, there is no common denominator when it comes to telehealth-related consent laws. For example, some apply specifically to the state’s Medicaid program while others apply to all telehealth services provided in the state, regardless of who covers the expense. [18]

Telehealth During the COVID-19 Crisis

COVID-19 pandemic set off an accelerated shift to virtual communication. Telehealth gives the opportunity for remote triage of patients, which in the current health crisis is safer for both them and the medical staff. By letting people receive necessary care without leaving their homes and increasing the risk of infection, telehealth becomes the new normal and more providers are willing to adopt it. [19]

According to a recent physician survey:

An overwhelming majority of doctors have “swiftly embraced” #telemedicine during the crisis. It concludes that the shift toward virtual connectivity and telehealth is here to stay and might transform the communication between the players in the healthcare system

The executives surveyed believe that telehealth will remain dominant as the world emerges from this crisis. [20]

Patients are also more willing to try virtual care now that the novel coronavirus is rapidly spreading.

Near 60% of patients who went through a telehealth appointment have had more than one.
36.92% would consider scheduling another appointment. 59.85% said that COVID-19 has increased their willingness to try telehealth in the future.
One quarter of respondents never considered this as an option before. [21]

Together with availability and affordability, the ability to get a potential diagnosis without being surrounded by sick people while waiting for the appointment, are the drivers making people consider another telehealth appointment. [22]

However, while COVID-19 fuels the growth of telemedicine, concerns are also rising. Emergency policy changes are lifting some of the federal restrictions on the use of the service. While this act is historic for promotion of virtual medical care, it also opens the ground for fraudulent activities that can range from financial frauds to bogus marketing schemes and illegal use of patient ID numbers to bill the government.

Investigators are already seeing “tons” of fraud cases linked directly to COVID-19. A common scheme is using patient accounts to bill for “coronavirus emergency kits” that turn out to be gloves and hand sanitizer or fake testing kits. [23] Loosed restrictions on drug prescription are also posing a serious threat.

Where to Now?

The COVID-19 pandemic has changed the way patients and physicians interact with each other.

Now more than ever people seek safety and that’s a the key reason why #telehealth services are becoming so appealing.

This shift is making providers that previously didn’t offer telehealth services rethink implementing the technology, at least in some form. This is an attempt to both answer the recent trends in patient care and a way to make up for the financial losses of cuts in otherwise profitable avenues, such as elective and planned surgeries. [24]

Now that these changes are a fact, policymakers might feel increased pressure to make permanent some of the emergency policies on telehealth. With more people noticing virtual care services and the increasing number of patients actually seeking online consultations, telehealth is gaining traction that is likely to last. The demand is prone to shift from seeking safer ways to treat and to check for COVID-19 symptoms, to pursuing safer and more convenient ways to get care for more mundane issues. This would allow the patients to get a consultation without the threat of contracting a virus while visiting a medical facility or spending time commuting to one.

The post-pandemic telehealth trends combined with the gaps in the legislation concerning these services, would require for drastic and permanent changes in the way telehealth is being handled both in-house (telehealth vendors) and by the legislature.