When up to 80% of in-person appointments had to be deferred, canceled or virtualized in order to limit COVID-19 exposure, telehealth went from a back-burner project to a necessity overnight. Virtual care is projected to account for more than 20% of all healthcare visits in the U.S. this year, driving $29 billion in total healthcare services.
But what will happen when the forced adoption of telehealth has passed? What might telemedicine look like in the “new normal” following the pandemic? Will it go back to a “nice to have” perk, or will it become an integral part of healthcare delivery in the U.S.?
Let’s explore several key aspects of telehealth.
Patient Sentiment Around Telehealth
Prior to the pandemic, only 14% of U.S. patients had tried telehealth. That number has skyrocketed by 57% since the COVID-19 outbreak—and by 77% for patients with a chronic illness.
The results have been largely positive, with patients becoming more comfortable with telemedicine:
- Doximity’s State of Telemedicine Report, published in September 2020, found that 23% of U.S. patients feel telemedicine is the same or better quality than an in-person visit; that number rises to 53% for patients with a chronic illness. Twenty-three percent plan to use telemedicine post-pandemic. Doximity expects that percentage to increase as telemedicine technology improves.
- A Penn Medicine study found that 67% of patients surveyed viewed its video and telephone appointments held during the height of the pandemic as “positive and acceptable substitutes to in-person appointments.”
- The National Poll on Healthy Aging, in a survey of 2,000 adults aged 50–80, reported an 11% increase in comfort with video conferencing technologies. Seventy-two percent of respondents said they were interested in using telehealth to connect with a provider they’d seen before. However, two-thirds felt that the quality of care in a telehealth visit was not as good as in-person.
It is not yet clear to what degree patients will prefer telehealth in the future. No doubt many patients will not want to give up the convenience of telehealth, especially if it saves them having to take time off from work to travel and sit in a waiting room. Others will prefer a return to in-person. Proximity to the facility, the patient’s comfort level with technology, and the type of appointment will all be factors.
Providers and patients will need to work together in this new landscape to determine not just what can be handled virtually from a clinical standpoint, but what should be. For example, sensitive discussions may best be handled in-person. In the Healthy Aging Poll, only one in three respondents stated they would be comfortable having an initial visit virtually. However, routine wellness checks and medication checks could easily be handled via telehealth, cutting down on travel and inconvenience for patients.
Telehealth and Chronic Illness Treatment
The Doximity report found that the top two specialties using telemedicine are endocrinology and rheumatology.
Paired with the higher desirability rating from patients with chronic illnesses, this highlights the benefits of telemedicine for treating long-term conditions like diabetes and arthritis. The frequent patient visits required for these conditions can be difficult and expensive for those with mobility challenges, chronic pain, unreliable transportation and/or daytime work schedules. The evolution of telemedicine, combined with at-home diagnostic and health monitoring tools, mean that these routine visits can be performed with more comfort and convenience.
The Doximity report predicts that telehealth will divert a significant percentage of emergency visits, becoming an important adjunct to home healthcare support.
Telehealth’s Impact on Patient Access
Telehealth has the potential to address long-standing issues of healthcare access for patients in rural and underserved areas. It could increase access to specialists in rural communities and make it easier for individuals with transportation challenges or who work multiple jobs to attend their appointments.
Some experts, however, wonder if telemedicine will not so much solve access problems as change the nature of the problem.
For example, many rural communities do not have access to reliable internet or cell phone service that will support telemedicine technology. Many low-income individuals who lack transportation to get to the doctor’s office also do not have sufficient internet access at home. While comfort with telemedicine is growing, many patients struggle or are unfamiliar with the technology. In the Healthy Aging poll, 17% of people over 50 still say they have never used any kind of video conferencing tool for any reason, including medical care.
As reliance on telehealth grows, it will no doubt become part of the larger national conversation about internet access as a utility rather than an optional service—as it is now all but required not just for healthcare, but for education, finding work, remote work, buying household necessities, paying bills, everyday communication and more.
Reimbursement & Regulation
Perhaps the biggest question mark in the future of telehealth is reimbursement.
Prior to the pandemic, telehealth was covered only in certain circumstances and was reimbursed less than in-person visits. This, along with concerns about privacy regulation, slowed the widespread adoption of telehealth. But when COVID-19 hit, the federal Centers for Medicare & Medicaid Services (CMS) and commercial payers relaxed regulations and increased reimbursement so providers could offer services to patients safely. Since the start of the COVID-19 pandemic, federal policymakers have enacted 31 changes to enable greater access to telehealth.
However, these emergency actions were temporary, leaving providers wondering if the benefits will end when the pandemic does.
There have been several promising signs for the future support of telehealth:
- In August 2020, the FCC approved $200 million in telehealth funding
- CMS has included new and expanded coverage for “connected health programs” in its proposed 2021 Physician Fee Schedule
- The Taskforce for Telehealth Policy has released recommendations to ensure the future of telehealth, including lifting limitations on originating sites, allowing telehealth for various types of conditions, and reinstating the HIPAA provisions lifted temporarily during the COVID-19 pandemic
- Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander has advocated that the originating site rule and the expansion of Medicare and Medicaid-reimbursable telehealth services be made permanent
- Congress is considering dozens of telehealth bills
- The states of Colorado and New Hampshire have already moved on making their temporary rules permanent
- Some commercial payers have announced that their policy changes will be extended through the end of the year or become permanent
Even so, uncertainty around payment models and federal government deadlock has many providers feeling uneasy about fully implementing telehealth long-term. Some worry about their ability to continue providing telehealth should insurance reimbursements drop back down. While telemedicine has lower overhead in terms of office space, there are greater technical demands. Some providers find that telehealth appointments take more time, not less, and are concerned about communicating that to payers.
Other providers find that that reduced delivery cost makes up for a difference in reimbursement. Still others plan to maintain or even grow their telehealth offerings regardless of reimbursement rates, because it is the best care delivery method for their patient base. Some providers are determined to maintain telehealth for rural and underserved populations, even if they have to cut back telehealth delivery in other areas due to lower reimbursement. In one thing all are in agreement: All are hopeful that CMS and commercial payers will maintain the COVID level reimbursement rates.
RevCycle Can Help You Adapt Quickly in the New Telehealth Landscape
Though the future of telehealth continues to evolve, there’s no doubt it’s here to stay. In order to adapt and thrive in this new landscape, it’s important to stay nimble. RevCycle can help with outsourced EBO services and collections that streamline your operations and reduce the burden on your internal staff.
Send us a message or call 888.576.5290 to schedule a phone consultation at your convenience. We’re happy to address any revenue cycle concern!