There was a massive uptick in telemedicine usage during COVID-19. But will it last?
It’s clear that COVID-19 has accelerated the adoption of telemedicine by physicians and their patients. But will it last? If so, how will it affect physician practices? What impact will it have on the types and volume of medical products and equipment they need?
As with just about anything COVID-19-related, no one knows for sure.
The evidence
Already before the pandemic, virtual office visits were on the rise. In February 2020, for example, the American Medical Association reported that physician adoption of televisits doubled from 14% in 2016 to 28% in 2019.
Then came COVID-19.
In April, Merritt Hawkins – a healthcare search and consulting firm – reported that almost one half of approximately 840 physicians surveyed between April 11 and April 15 reported seeing patients via telemedicine. The firm contrasted that result with The Physicians Foundation’s 2018 Survey of America’s Physicians, also conducted by Merritt Hawkins, which indicated that two years earlier, only 18% of physicians were treating patients through telemedicine. “The emergence of the virus has clearly accelerated the use of technological platforms used to treat patients remotely,” noted the company in its most recent report.
Signs of increasing usage were widely reported during the pandemic. For example, NYU Langone Health, an academic health system in New York City, reported that between March 2 and April 14, telemedicine visits increased from 369.1 daily to 866.8 daily (135% increase) in urgent care, and from 94.7 daily to 4,209.3 (4,345% increase) in non-urgent care. NYU Langone Health comprises four hospitals and more than 500 ambulatory locations, and 8,077 healthcare providers.
“From Henry Schein’s vantage point, we’re seeing an uptick in the adoption of telemedicine by entire health systems, as well as solo practitioners, urgent cares, and ER departments,” says Michael Casamassa, vice president of solutions and planning, Henry Schein Medical.
Greg Dean, vice president, technology and services, McKesson Medical-Surgical, points out that “COVID-19 has driven – and the relaxed regulations have allowed – many more providers and patients to use telehealth. Only time will tell, but the current general feeling is this will advance telehealth.”
The government responds
In response to the increased demand for virtual visits during the pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services. Effective March 6, beneficiaries could receive a wider range of services from doctors without visiting a healthcare facility. (Prior to this, Medicare would only pay for telehealth on a limited based, when the person receiving the service was in a designated rural area, and when they visited a clinic, hospital or other medical facility.)
On April 30, CMS waived the video requirement for interactive conferences, thus allowing Medicare beneficiaries to use audio-only telephone to receive services. In addition, CMS waived limitations on the types of clinical practitioners who could furnish Medicare telehealth services, including physical therapists, occupational therapists and speech language pathologists.
After COVID-19
Some of these waivers may expire when the public health emergency has ended. But what happens after that?
“Providers who were on the fence prior to COVID-19 are looking for a more robust solution to fit the changing needs of their practice,” says Dean. “Others will retreat after the pandemic. There is a basic wait-and-see attitude concerning which regulation and reimbursement changes remain in place post-COVID-19.
“The federal government has invested greatly in telehealth during the crisis and paved the way for future adoption. Looking five years or more down the road, we may see virtual care integrated into the workflow for providers as part of specialist consults, follow-up and monitoring.”
But telemedicine won’t replace all in-person visits, he says. In fact, quite the opposite.
“As providers learn how to leverage this tool and balance their patients, it may grow in-person visits. By directing patients who do not need an office visit to telehealth, a provider has time to see more of the critical patients – reducing wait times to get an appointment. Telehealth, or virtual care, also makes it easier to follow up with patients – these are often missed visits. And, with the ability to connect easily to a provider, it may reverse the trend and reconnect patients to their primary care provider.”
Telemedicine alone isn’t primary care
Steven Waldren, M.D., vice president and chief medical informatics officer for the American Academy of Family Physicians, predicts a significant increase in the utilization of telemedicine in the years ahead. “That assumes that reimbursement for telehealth remains post-public-health emergency and we continue the move toward value-based payment.”
But stand-up “virtual primary care” options are not the answer, he says. That’s because the cost-effectiveness and high quality of primary care rest on four things: contact, continuity, coordination and comprehensive care. A virtual-only model could deliver first contact, but not the other three. “That is not primary care.”
Stand-alone telehealth presents some questions insofar as diagnostics are concerned, adds Walgren. “Broad adoption of telehealth could create a significant market for patient-administered testing, particularly if services similar to UberEats and DoorDash deliver testing supplies quickly,” he says. “But without the option to step up a virtual visit to in-person, it may drive the utilization of more diagnostics/point-of-care testing and more referrals to subspecialties.
“If a telehealth provider can only deliver care virtually, they may decide to do more testing than a physician who has the option to see the patient in person.”
What’s more, not all issues can be addressed via virtual technology, such as administering vaccines or palpating a patient’s abdomen, says Waldren. “However, telehealth and telemedicine technology can facilitate distanced communication between patient and physician on qualitative questions and discussion.”
And although some patients might opt to substitute telehealth for at least some office visits, others may end up having a very similar number of in-person visits, he says. Those with chronic conditions, for example, might use telemedicine to engage more intensively with their physician and the care plan between in-person visits.
Protocols needed for virtual care
Growing acceptance of telemedicine may force providers to take a closer look at which visits lend themselves to virtual appointments, and which ones demand face-to-face visits, says Chris Smedley, vice president of physician enterprise solutions for Premier.
“This is such a critical question that medical groups across the country are contemplating, and there is no perfect answer. However, clinical necessity should and has to be a key driver in making these decisions.
“The severity of the condition and ability to move quickly from diagnosis to treatment will likely be key factors in determining these protocols. Providers are now being asked to inform new scheduling protocols that triage patients based on clinical guidelines and pathways for either an in-person visit or a virtual one. Key to success will be the physicians and staff working together to come up with models that are easy to implement and sustain.
“It will be important for providers and the clinical staff to work together to carefully construct questionnaires to identify which visits qualify for an in-office appointment versus virtual care. Central to all of this is ensuring patient comfort, safety and wellbeing.”
Practices must also consider that following the pandemic, patients may be skittish about seeking on-site care due to concerns of potential virus transmission, adds Smedley. “Many patients will opt for convenience and safety, which means they may choose not to visit a provider in-person if they can avoid it.”
Even without post-COVID-19 concerns about virus transmission, however, societal trends point toward a greater acceptance of telemedicine, he says.
“We’ve already seen a rapid shift in patient values where, oftentimes, their preference for a virtual visit drives how they choose to interact with a practice. … Furthermore, due to the economic impacts of COVID-19, such as unemployment and the potential for lost or reduced wages, people are going to be more selective about when they choose to see a healthcare provider.” The proliferation of high-deductible health plans over the last decade has already made people more selective about seeing a healthcare provider.
“There will be a downshift in in-person visits, and health systems will have to reevaluate both the use of the physical space as well as care delivery models if volumes don’t return,” says Smedley.
Convenience and safety
Mike Casamassa of Henry Schein believes that the adoption of telemedicine post-COVID-19 depends on many variables, including how quickly states reopen, how quickly clinicians get back to work, and how fast treatments or a vaccine are available.
But patients value convenience and safety and will likely demand telehealth where and when it is appropriate, such as for low-acuity conditions like minor scrapes, bumps and bruises, and respiratory illness, he adds. Furthermore, as technology advances, the use of telehealth may expand to dental, ophthalmology, and remote patient monitoring, specifically, for high-acuity, at-risk patients with two or more chronic diseases. Behavioral health issues are also appropriate for telehealth.
“Additionally, the patient intake process of telehealth, which is automated and touchless, will likely cross over to all physical visits,” he adds. “If the collection of information prior to a virtual visit can be done in an automated and touchless manner, we can expect physical visits to be conducted the same, and more candidly, demanded by patients.”
Supply chain ramifications
By understanding the impact telehealth will have on the traditional delivery models of healthcare, distributors will be better positioned to expand their portfolios and support their customers with new solutions, says Casamassa.
Henry Schein did just that years ago by partnering with telediagnostic company Medpod Inc., he points out. Last summer, the distributor announced the availability of Medpod MobileDoc 2, and entered in a new agreement with Uber Health, which enables healthcare professionals to deliver telediagnostic examinations in non-traditional care settings, including the home or workplace.
McKesson Medical-Surgical’s Greg Dean believes that the growing usage of telemedicine could lead to more diagnostic testing. “Being able to connect quickly with a patient through telehealth or remote monitoring, doctors can initiate more timely visits for needed care and testing,” he says. “It may also drive the development for more home testing.” As for medical supplies, telemedicine may drive down the demand for some, but increase the demand for others, as the complexity of visits changes, he adds.
Says Premier’s Smedley, even if telemedicine leads to a dip in office visits, physician practices will always need personal protective equipment. “In many cases, organizations will seek alternative strategies to offset potential supply shortages through sterilization, conservation and reuse practices where applicable.” In addition, because providers had to ramp up their telemedicine services so rapidly during the pandemic, they may reevaluate their longer-term strategy with these tools and solutions, he adds.
Physician preference
“We won’t fully understand the long-term impact of virtual care on providers for some time,” says Smedley. “Some clinicians love providing care through telemedicine portals, while for others it exacerbates the symptoms of burnout because of the perceived distance from their patients and the lack of connection.
“As health systems adopt care delivery models to understand what patients need, they will also have to account for the effect on their clinicians and doctors. They’ll need to strategically attend to those clinicians and physicians who may gravitate toward virtual care versus those who prefer providing care in an office setting.
“There will be an economic impact on ancillary revenue, although it’s unclear today the degree to which these services will change,” he adds. “With more visits shifting to virtual care, health systems and medical groups are going to need to be creative and proactive to mitigate declining volumes for labs, X-rays, point-of-care testing and other procedures that are often administered during an appointment.
“Coming out of the pandemic, there is a sense of urgency to recoup lost visits and ancillary revenue. In the fee-for-service model, volume is an important leading indicator relative to revenue. The pandemic has spotlighted how value-based care models can help stabilize providers’ revenue compared to volume-based payment models.
“This may provide a tipping point in order to further motivate medical groups to participate in more risk-based contracting efforts.”