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By: Gordon Chan

Hospitals and doctor’s offices have been notorious breeding grounds for germs and deadly pathogens long before COVID-19. The pandemic has brought that reality further into light, leaving sick people wary of risking their health by going to healthcare facilities.

This resulted in a dramatic drop in clinic and hospital visits. Total non-COVID-19 related hospital admissions dropped to as low as 68.6% of predicted admissions during the early stages of the pandemic. And between the stay-at-home mandates and office closures, healthcare providers are looking for alternative ways to deliver care to patients from the safety of their homes. Telehealth has quickly become a solution to an immediate problem.

What is Telehealth?

Telehealth, sometimes called telemedicine, refers to the use of electronic information and telecommunications technologies to deliver and facilitate health-related services. Several technologies are being used to deliver telehealth, including live videoconferencing, store-and-forward videoconferencing, and remote patient monitoring.

Patient meeting with physician through live videoconferencing
Source: Telehealth VA

Live videoconferencing is the real-time interaction between a patient and a provider through telecommunications technology. Physicians can use live videoconferencing for consultative, diagnostic, and treatment services. This type of service offers cost-effective access to care for patients with poor access to healthcare professionals. For example, patients from rural areas can use live videoconferencing to receive medical consultations at home without the need for travel or consult with medical specialists who are not available locally. 

Store-and-forward videoconferencing is asynchronous, meaning patients and physicians do not interact in real-time as they do through live videoconferencing. Instead, store-and-forward videoconferencing is a method by which healthcare providers share medical information, such as lab reports and imaging studies, with specialists at another location. This form of telehealth provides data through a secure electronic communications system, such as secure email, to a specialist who uses the information to aid in diagnosis and medical consultations during live video conferencing. 

Another type of healthcare delivery that uses telehealth technology is remote patient monitoring (RPM). This type of service uses technology to move healthcare out of the traditional setting of hospitals and into the patient’s home. RPM typically involves collecting, evaluating, and reporting patient health data through wearable electronic devices such as mobile phones, smartphone apps, and smart watches. RPM technology provides physicians with a constant stream of health data so that they are better equipped to understand and manage patient health situations.

Benefits of telehealth

Significant changes were needed to minimize the spread of COVID-19. Healthcare systems had to adjust the way they delivered healthcare during the pandemic and telehealth technology was one solution. According to the Centers for Disease Control and Prevention (CDC), there was a 154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019.

This sudden rise in telehealth visits can be attributed to social distancing strategies to minimize infectious exposures. Telehealth services allow healthcare professionals to maintain continuity of care while abiding to public health mitigation strategies. It is bridging the gap between patients and physicians and enabling everyone to stay at home during this pandemic. Telehealth also reduces the strain on healthcare systems by reducing the pressures facing emergency rooms. Patients suffering from medical conditions other than COVID-19 can receive care remotely from their home and minimize their risk of contracting COVID-19. For example, physicians can provide low-risk urgent care for non-COVID-19 conditions and identify individuals who may need additional medical consultation and refer them to specialists. 

Patients with transportation or mobility issues have also benefited from the increased telehealth adoption. The CDC’s  National Center for Chronic Disease Prevention and Health Promotion has been supporting telehealth programs to improve the health of rural residents and for people with disabilities. Many of these programs focus on chronic disease prevention and access to specialist care such as diabetes management and stroke rehabilitation. 

Increasing trend in use of digital health tools from 2016-2019
Source: American Medical Association Digital Health Research

Challenges of telehealth

While telehealth can be a beneficial alternative to traditional healthcare delivery, there are also major challenges to telehealth. One downside of telehealth is how it affects the patient-physician relationship. The physical interaction between a physician and patient during in-person visits is an important component of patient care that allows a physician to build trust. Doctors and patients get to know each other on a deeper level and improves satisfaction for both parties. Dr. Hyman, author of The Disappearance of the Primary Care Physical Examination–Losing Touch explores the lost human connection when physicians treat their patients exclusively through a screen. 

In the article, Dr. Hyman describes the ritual of going through the motions of a hospital visit. There’s almost something therapeutic about going to the office and being examined that provides comfort to the physician and patient. In his experience, sometimes patients can be distracted during a virtual visit. They could be distracted by their email notifications or their children playing next doorin the next room. All these distractions impair the remote experience and can affect health outcomes. Whereas duringDuring an in-person visit, on the other hand,  when the patient is fully present, there are less opportunities for such distractions. 

According to his experience, some diagnoses cannot be made without examining a patient in person. In his 15 years of experience, he has developed a method of active listening, using critical thinking skills, and offering expertise to the patient. However, the pandemic has forced him to deconstruct his routine and leaves him uncertain about his professional skill and ability to deliver quality care to his patients. While telehealth became a necessary tool to combat the pandemic and minimize potential COVID-19 transmission, he has no doubt that there will be a re-examination of the role of in-person visits. 

Concerns about telehealth visits among adults 50-80 in June 2020
Source: University of Michigan

Policy Recommendations 

Before the pandemic, there was already increasing interest towards telehealth technology adoption. However, recent policy changes in response to the pandemic have reduced barriers to telehealth access and have promoted telehealth as a cost-effective method to deliver medical care. 

“The challenge with telehealth in the past was that many insurances would cover it, but they would cover it significantly less than they would for in-person visits,” said Carmel Shachar, executive director of the Petrie-Flom Center for Health Policy, Biotechnology, and Bioethics at Harvard Law School. “Therefore, healthcare providers were incentivized to avoid telehealth at all costs and to encourage people to come into hospitals and clinics.”

But this has been a long-standing issue within the U.S. healthcare system. Healthcare policy makers are reluctant to change this system as it would significantly add to the $644 billion Medicare budget. Patients end up incurring the additional costs of unnecessary testing and office visits.

In response to the coronavirus threat, the federal government has mandated payment parity for telehealth services across all insurers. With the telehealth regulation relaxed, doctors or any other licensed professional that provides telehealth services will be reimbursed the same amount as if the appointment had happened in person. Instead of paying based on where the service is provided, providers are being paid based on what services they provide. For example, a telehealth visit that talks about a patient’s diabetes will be charged the same as if that patient had come into the office to talk about their diabetes. This change is a win for both parties involved. Healthcare providers are able to provide telehealth services, which are cheaper to deliver, and patients can access the same services they would in person without the risk of contracting COVID-19.

Amwell consumer data on how telehealth visits could save patients time and money
Source: Amwell telehealth data

When the pandemic ends, which could be sooner than later, the temporary changes to telehealth regulations will expire. When this happens, it’s imperative that the U.S. does not revert to pre-COVID-19 telehealth regulations. To ensure that the momentum for telehealth services during the pandemic is not squandered, Shachar believes payment equity, rather than parity, must be realized after the pandemic

Because telehealth visits are shorter and cheaper to provide, healthcare providers are not incentivized to maintain telehealth practices post COVID-19. However, payment equity suggests that telehealth visits be reimbursed similarly, but not identically, to in-person visits. She acknowledges that further studies will be required for further consideration but is adamant that payment equity should be considered to sustain the increased use of telehealth during the pandemic.