Covid Was a Tipping Point for Telehealth. If Some Have Their Way, Virtual Visits Are Here to Stay.

As the covid crisis wanes and life approaches normal across the U.S., health industry leaders and many patient advocates are pushing Congress and the Biden administration to preserve the pandemic-fueled expansion of telehealth that has transformed how millions of Americans see the doctor.

The broad effort reaches across the nation’s diverse health care system, bringing together consumer groups with health insurers, state Medicaid officials, physician organizations and telehealth vendors.

And it represents an emerging consensus that many services that once required an office visit can be provided easily and safely — and often more effectively — through a video chat, a phone call or even an email.

“We’ve seen that telehealth is an extraordinary tool,” said David Holmberg, chief executive of Pittsburgh-based Highmark, a multistate insurer that also operates a major medical system. “It’s convenient for the patient, and it’s convenient for the doctor. … Now we need to make it sustainable and enduring.”

Last fall, a coalition of leading patient groups — including the American Heart Association, the Arthritis Foundation, Susan G. Komen and the advocacy arm of the American Cancer Society — hailed the expansion of telehealth, noting the technology “can and should be used to increase patient access to care.”

But the widespread embrace of telemedicine — arguably the most significant health care shift wrought by the pandemic — is not without skeptics. Even supporters acknowledge the need for safeguards to prevent fraud, preserve quality and ensure that the digital health revolution doesn’t leave behind low-income patients and communities of color with less access to technology — or leave some with only virtual options in place of real physicians.

Some worry that telehealth, like previous medical innovations, may become another billing tool that simply drives up costs, a fear exacerbated by the hundreds of millions of dollars flowing into the burgeoning digital health industry.

Companies offering remote urgent care, virtual primary care and new wearable technologies to monitor patient health are exploding, with the annual global telehealth market expected to top $300 billion by 2026, up nearly fivefold from 2019, according to research company PitchBook.

“I don’t think there’s any debate that there is a value in better access, but if this is just a one-off service that adds another billing option without fitting into patients’ regular care, I don’t know if it will do much for patients’ health,” said Tom Banning, head of the Texas Academy of Family Physicians.

Perhaps the most contentious issue facing politicians, insurers and hospitals is how much a telehealth visit is worth in a system that is already breaking the bank.

While Medicare and other insurers fueled the explosion of telehealth over the past year by paying the same rates as for in-person visits, many are expected to push for lower prices when the federally designated public health crisis ends. At the same time, physicians and hospitals are looking to maintain income.

“Payers are unlikely to give providers carte blanche,” said Dr. Hoangmai Pham, a former senior medical official at health insurance giant Anthem. But Pham noted insurers could reward physicians and hospitals that take greater responsibility for their patients’ overall health with higher rates for telehealth. “There’s an opportunity here,” she said.

For now, tens of millions of Americans have gotten used to meeting their doctor on a laptop or smartphone, and pressure is building on the federal and state governments to loosen rules to preserve virtual visits after the health crisis ends.

“I don’t want to go back,” said Suzy Brantley, a 67-year-old Texan who works at an accounting firm outside Dallas.

Brantley has been going to the same medical practice for more than 15 years. “I love them there,” she said. But when the practice closed its doors last spring, requiring virtual visits, Brantley found she enjoyed the more convenient way to do routine business like refill a prescription.

“You don’t have to leave work to go to the doctor,” she said. “I can just step into the break room for a few minutes and use my phone. … I love it.”

She’s far from alone. In a nationwide poll last year, 8 in 10 Americans who had used telehealth said they “liked it” or “loved it.” Nearly the same share said they were likely to continue using it after the pandemic, according to the survey by the Harris Poll.

Just a year ago, telehealth — or telemedicine, as it’s also called — was largely a curiosity. Patient and physician wariness and strict rules about how doctors could bill had squelched widespread use.

Fearing fraud and overuse, the federal government tightly restricted the kind of video and audio visits that could be billed to Medicare, limiting use mainly to rural areas and to visits in which a doctor was in an office or hospital, rather than working remotely.

“There was a fear that if there was the slightest opening in the Medicare payment system, people would find a way to abuse it,” said Sean Cavanaugh, who oversaw Medicare during the Obama administration.

That changed suddenly in spring 2020 as pandemic lockdowns shuttered physician offices. Almost overnight, doctors were forced to pivot to virtual care to maintain contact with patients and keep money flowing.

This article originally appeared in Kaiser Health News, read more here.

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