Telemedicine Today

That anyone can now talk to their doctor 24/7 and from anywhere – from home, from the office, or while away on vacation – is not wishful thinking anymore. With COVID-19 driving and hastening changes all around us, telemedicine is no longer just a nice-to-have, but a new imperative for both patients and providers.

What is telemedicine?

According to the American Academy of Family Physicians, telemedicine is “the practice of medicine using technology to deliver care at a distance.” One clarification – whereas telemedicine refers specifically to remote clinical services, the term telehealth refers to a broader scope of services which may include non-clinical services.

Why telemedicine?

• It increases access to healthcare. It is a way to extend treatment to those who otherwise would have to travel “over the river and through the woods” to receive treatment
• It benefits providers. Extending access increases market share for clinicians, giving them a new source of revenue and larger patient base, thereby improving the bottom line
• It improves patient-centered care. Telemedicine is a particularly effective tool for patient education initiatives linked to population health, by allowing elderly and chronically ill patients struggling with mobility issues to receive care. Patient compliance can be monitored, and communication improved so that patients have the tools they need to better manage their care and stay engaged
• It increases affordability. Both doctors and patients are suffering from spiraling costs. For patients, telemedicine eliminates the travel cost associated with a traditional visit, from time off work and childcare to gasoline and parking. For providers, the reduced overhead of a virtual visit is a strong positive (while an average in-person visit costs $125, an average telehealth visit is just $45)

Technologies used to enable telemedicine

• Patient portals allow you to communicate with your primary care provider, request prescription refills, review test results and summaries of previous visits, and schedule appointments or request reminders
• Virtual appointments enable you to see your doctor or a nurse via online videoconferencing
• Remote monitoring, including mobile apps for uploading data (e.g., blood glucose readings) to your doctor, devices that measure and transmit data (blood pressure, blood glucose, lung function), wearables that automatically record and transmit data (heart rate, blood glucose, gait, posture control, tremors, physical activity, or sleep patterns), and home monitoring devices for older people or people with dementia that detect changes in normal activities such as falls
• Doctors talking to doctors, allowing primary care doctors to get input from specialists when they have questions about your diagnosis or treatment – by sharing exam notes, history, test results, X-rays or other images. The specialist may respond electronically, conduct a virtual appointment with you at your doctor's office or request a face-to-face meeting
• Personal health records, which are a collection of information about your health that you control and maintain via a web-enabled device. In an emergency, a PHR can quickly give emergency personnel vital data such as current diagnoses, medications, drug allergies and your doctor's contact info
• Personal health apps help consumers organize their medical information in one secure place. These tools help consumers store personal health data, record vital signs, calculate and track caloric intake, schedule reminders for taking medicine, and record physical activity such as daily step counts
• AI-based software used on the front-end of a patient encounter, acting as the triage person. The software gathers data and uses logic to determine the best sequence of questions to ask the patient

With COVID-19, what happens now?

After the slow traction that telemedicine had gained in the recent years, it has now been propelled to the forefront of healthcare, aided in no short measure, by the COVID-19 pandemic. Primary care clinics are among the most impacted. By various measures, they saw an almost 2/3^rd decline in office visits, though it has now started to recover. Faced with bankruptcy, primary clinics have had to respond quickly by offering telemedicine visits to patients. Not only has that prevented these clinics from going out of business, but also ensured that patients receive at least some level of care during the pandemic. This trend seems irreversible as telemedicine becomes an important part of their services. The adoption of telemedicine has shifted into hyper-drive over the past month, with virtual interactions on pace to top 1 billion by year’s end, according to Forrester Research. But is this just a trend, or a permanent shift?

There are reasons to believe that telemedicine is here to stay and flourish, among them:

• Increasing adoption across care settings, including rapid growth in behavioral health, dermatology, and cancer care. Providers and patients alike are more open to embracing the technology
• Lower regulatory barriers. Regulatory changes that the industry and entrepreneurs had been pushing to change for the past decade or more, changed almost overnight. Under the CARES Act of March 2020, there is a provision that specifically encourages the use of telehealth. Those services can now be provided to patients at any location – not just to rural and established patients. Telehealth across state lines is still up for debate, but some states are already allowing this to happen.
• Improved financial reimbursement. Medicare, Medicaid, and private insurers have started to reimburse providers at the same or comparable rates to in-office visits, relieving the financial pressure on providers, creating strong incentives to adopt telemedicine, and allowing practices to stay afloat
• Technological innovations that allow telehealth to connect with medical devices such as stethoscopes, infrared thermometers, otoscopes, etc., are taking telehealth even further
• Telemedicine is the new “house call.” While physical examinations and other procedures will still need to take place in person, things like follow-up visits, medication management and mental health assessments could be carried out via video or telephone
• Value based care gets fresh impetus. Advocates for primary care have suggested that Medicare pay practices a fixed fee of $50 every month for every Medicare patient the practice has, as a simple way to keep doctors’ offices open. Normally, doctors are paid through a fee-for-service arrangement, in which they bill for each office visit and each procedure. Experts have long argued that this system creates the wrong incentives, forcing physicians to scramble to squeeze in as many office visits as they can, rather than thinking more about what services would deliver the best results for patients. A fee-for-service system gives doctors little incentive to switch to more telehealth, since they would have to bill less for the service. A single monthly payment, on the other hand, can encourage physician practices to redesign the way they deliver care – all the while allowing doctors and patients to remain in close contact and better manage chronic illnesses through telemedicine.

However, a tale of caution

While telemedicine has potential for better coordinated care, it also runs the risk of fragmenting health care, leading to gaps in care, overuse, inappropriate use of medications, or unnecessary or overlapping care. Insurance reimbursement for telehealth still varies by state and type of insurance. Also, some people who would benefit most from improved access to care may be limited because of regional internet availability or the cost of mobile devices.

Conclusion

Telemedicine is no longer just a nice-to-have, but an imperative for both patients and providers. COVID-19 has forced the government and healthcare systems to ramp up their telemedicine offerings quickly – to avoid putting healthcare workers at risk – in the process starting what’s almost guaranteed to be a permanent shift in how care is delivered across the globe.