Is Telemedicine The Future Of Health Care?

The novel coronavirus pandemic has stretchedhealth care systems to the brink.

Covid-19, might be getting allthe headlines, but patients are still getting sick fromother diseases and injuries.

And that's left doctors looking forother ways to treat them while minimizing contact.

Enter telemedicine.

Telemedicine is broadly defined asthe use of electronic communications and software to monitor and treat patientsin lieu of an inpatient visit.

Over the past decade, telehealth, abroader term used to define all medical services and health educationdelivered digitally, has grown steadily as an industry.

According to IBISWorld, the industry's revenuehas grown 34.

7 percent from 2014 to 2019.

The market size in 2019 was around45 billion dollars, but it's projected to grow to more than175 billion dollars by 2026.

Despite the increase in revenue, Americanshave been slow to adopt the practice.

According to a 2017study, 82 percent of U.

S.

consumers don't use it.

Like all of American life, thatchanged with the novel coronavirus.

The number of Medicare patients usingtelehealth has increased from roughly 11, 000 a week to morethan 650, 000 people a week.

It's led to a surge in usagefor telemedicine companies such as Teladoc and American Well.

And video conferencing companyZoom, whose stock is up more than 150 percent sincethe start of 2020.

Shares of Microsoft, which owns videoconferencing software Skype and its teams platform, are up more than 14percent since the start of 2020.

Telemedicine visits surged to 50 percent inMarch and are on pace to reach 200 million by the end of 2020.

That's up from earlier predictions of36 million America's health care system has skipped the test run andjumped to using telemedicine as a primary means of careduring the coronavirus pandemic.

Here's how coronavirus could changethe future of U.

S.

health care.

Telemedicine dates back to the mid 20thcentury when radios were used to provide medical advice on ships.

In hospitals, the first usage was inthe 1950s through a closed circuit television link forpsychiatric consultations.

In the last 30 years, telemedicinetreatment has expanded to mental health, stroke and patients with chronic diseaseslike asthma, diabetes or heart failure.

A number of research studies havefound it to be an effective alternative and satisfying for boththe patient and provider.

Telehealth proponents have sold it asa solution for patients in rural areas.

Now they advocate it as alow cost and convenient option for tech savvy millennials and busyparents as well.

A 2019 American Well study found that66 percent of Americans are willing to use telehealth, but only eightpercent had already tried it.

Dr.

Michael Barnett is an assistantprofessor of health policy and management at the Harvard T.

H.

Chan School of Public Health and aprimary care physician at the Brigham and Women's Hospital in Boston.

He's published papers about telemedicineadoption in the U.

S.

There are many different reasons whythe use been so low.

The first is that insurers are veryworried that people would use too much telemedicine if they coveredit too easily.

And so there are lots of restrictionson the kind of telemedicine visit that insurers will pay for.

So, for example, Medicare, which isthe big federal government payer that covers older adults and the disabled, they only pay for telemedicine if somebody is a rural resident.

And you also have to go to aspecific kind of facility with a specific kind of equipment and has to bea doctor that you've already seen.

In addition to that, in the U.

S.

, I think people are really quite attached to seeing their doctors in person.

Doctors or, also, their business modelis very much tied to seeing patients in the office.

So they don't have a lot ofincentive to offer telemedicine because there isn't really a wholelot of patient demand.

So when the government announcedthat they would lift telehealth restrictions for Medicare, itwas a big deal.

Today, we're also announcing adramatic expansion of our Medicare telehealth services.

Medicare patients can now visit any doctorby phone or video conference at no additional cost, including withcommonly used services like FaceTime and Skype.

The move paved the wayfor private insurers and others to waive their restrictions.

However, the newexceptions didn't void requirements states might have for telehealth.

Telemedicine has been cast as atool to protect medical professionals from exposure to Covid-19, to helpreduce reliance on personal protective equipment and keep the vulnerableand healthy at home.

Now, coronavirus could boost telehealth interactionsto one billion by the end of 2020.

Telemedicine companies likeTeladoc and American Well have seen a big boost inusers during the coronavirus pandemic.

They've been able to meet demandthanks to most states temporarily modifying their license requirements for doctors, meaning a doctor in one state can diagnose apatient in another state.

That's led Credit Suisse listing Teladoc asone of their top 10 investment ideas amid Covid-19.

Berenberg Capital Markets predicts thecompany's market opportunity can only head upwards.

And William Blair has called it theonly clear beneficiary of the Covid-19 outbreak in our universe.

Even tech companies areentering the telemedicine space.

Here's CNBC reporter Cristina Farr onthe growing overlap between health and tech.

So all of the majortech companies out in Silicon Valley have been interested in telemedicine now foryears and have been studying ways to incorporate itinto their products.

Microsoft, for instance, has beendeveloping chatbots, has collaboration software like Teams.

They also havevideo conferencing services.

Same with Apple, same Google.

And increasingly, they're finding ways topoint people to use these sorts of services.

While telemedicine on paper looks like anear perfect solution for policymakers.

It isn't always the bestsolution for providers or patients.

Dr.

Jessica Bender is a primary caredoctor and a clinical instructor of medicine at theUniversity of Washington.

Telehealth is not for all issues.

We want to provide the right care tothe right patient at the right time.

Some medical issues just cannot be resolvedover the phone or over video and require an in-person visit.

Doctors are not always paid the same amountfor a virtual visit as they are for an inpatient visit.

As of December 2019, only 10 states paythe same amount or have what they call payment parity laws.

There are a number of states thathave passed so-called parity laws that basically force insurers to pay thesame amount of money for a telemedicine visit asan in-person visit.

And the fact that telemedicine paysless than in-person visit is another reason why it's been adopted less becausenot only are there all these requirements for whether you get paid ornot, but also in many situations, doctors may not get paid asmuch for doing the same service.

Additionally, to access telemedicineservices, patients need reliable Internet access.

And according to a2020 Broadband Now study, 42 million Americans don't have access to awired or wireless broadband connection.

Telehealth has a risk ofexacerbating pre-existing inequities in health care, in either access tocare or in health outcomes.

We talk about somethingcalled the digital divide.

So large parts of the country are ruraland may not have access to high speed internet, for instance.

Many of my patients whoI see are unhoused.

They don't have phones, they don't haveInternet or they might not have a safe place or private placeto be for a visit.

And so if we leave those folks outof our approach to telehealth, we will just make health inequities worse.

In the U.

S.

, more than 50 healthsystems such as the Cleveland Clinic of Ohio and Mount Sinai in New YorkCity have telehealth systems to conduct a virtual check-ins with patients.

While most health systems have been ableto quickly adapt, there are still ways to improve.

We're seeing hospitalsstart to strike these deals with telemedicine companies.

Right before the pandemic, we sawCleveland Clinic, for instance, a big medical institution, sign a deal withAmerican Well, one of the largest telemedicine providers.

And that's true across many of theselarge hospitals that have gone from having some kind of telemedicine optionthat's available, but very few people know about it.

To nowpushing telemedicine front and center, marketing it, emailing it, putting itright up on their websites for people to use, really trying to makesure that they are aware that the option exists.

Massachusetts General Hospital, oneof the top hospitals in the United States, has been using amix of existing and in-house platforms to meet care.

Dr.

Lee Schwamm is the Director ofthe Center of Telehealth at Massachusetts General Hospital and the Vice Presidentof Virtual Care at Partners HealthCare.

In the beginning of March, before Covid really came to us, maybe four weeks ago, we did aboutsomewhere between 0.

7 percent and 0.

8 percent of all of ourambulatory visits were over telemedicine.

This week, we're doingmore than 75 percent.

We also created a program where wemounted an iPad on some specially configured hardware to attachit to an I.

V.

pole and turned it into an alwayson video intercom so that we could reduce the need for providers to puton protective equipment, which is in very short supply.

But continue to engage with patients ina way that's much more compelling than just over the nursing call bell.

The University of Washington Hospitaloffers a number of telemedicine services for specialties.

However, like most hospitals, notevery service was equipped for telemedicine.

The high demand for carehas left hospitals and practices to retrain physicians on how tocare for patients virtually.

In our healthcare system, we have anonline training that everyone who is credentialed in telehealth needs to complete, and that teaches us how, logistically, how to do telehealth.

It gives us some tipsabout setting up a space.

So I'm lucky I'm inmy basement at my house.

I have a separate roomwith a closed door.

It's quiet.

When I am actually interactingwith patients, I make sure I wear my badge and that it's visible.

Telemedicine has adapted quickly duringthe time of coronavirus.

However, the practice hasn't been aperfect transition for all forms of care, especially for doctors who areused to seeing patients every day.

It's been disorienting to seeso few patients in person.

For a lot of doctors, this hasbeen a learning experience, to put it mildly, because we are so used to havingour priority list and how we take care of our patients dictated bywho's on our schedule that day.

And now we just don'thave the same mechanism.

Another thing that has become veryimportant in this tragic crisis are serious illness conversationswith patients.

Talking with patients and their familiesabout their choices and if they have chronic medical conditions, talking aboutwhether or not they would want to be on a ventilator iftheir illness progressed rapidly due to Covid and they could not breathe.

So, again, many of the things thatwe used to take for granted would happen in person.

We've now been forcedto reinvent in this video only environment.

Telemedicine has helped maintainsome business for the health care industry, but volumes ofvisits are still down.

That could hurt the systemfinancially over the long term.

One of the primary care clinics whereI work, it looks like, our in-person visits have decreased probably by80 to 90 percent.

So they're at levels of 10 to20 percent of what they previously were.

And then our telehealth visits, make up, bring us back to our prior levels.

So if we had before 100 visitsa day, now we have maybe 20 in person and 50 to60 telehealth visits.

Something the federal government, I think, needsto catch up on is that the way they haverelaxed telemedicine regulations.

They still don't pay really nearly enoughfor practices to make up for the lost volume that they're experiencingright now because patients are really either staying home and visitvolumes are plummeting across the country for practices everywhere, andit's especially hitting small and medium practices hard.

And doctors aren't necessarily makingup that volume with telemedicine.

But also telemedicine visits only pay athird or even less of what a normal in-person visit would pay.

So they're getting hit doubly hard.

Hospitals and other health care providersare slated to receive about 175 billion dollars to make up for theincreased costs and lost revenue as part of the Coronavirus Aid, Relief and Economic Security Act.

However, it might not beenough to save them.

This crisis has an enormousfinancial impact on hospitals.

We've canceled all of the elective casesthat are what help support the mission of the hospital, and we are nowcaring for the sickest of the sick and those patients are staying in thehospital for a very long time.

And so without federal and state relief, this is an impossible burden for hospitals to carry financially.

And we may be very much atrisk of hospital bankruptcies because of the extraordinary concentration of needing tospend more money, acquire more supplies, care for the sickest of patientsand at the same time, no longer have the mainstay, the bread andbutter of the procedures that largely fund the operations of the hospitals.

Cleveland Clinic predicts within five years, half of the outpatient visits in the U.

S.

will be virtual.

After this pandemic is over, telehealth willbe here to stay and people w ill want, they won't want togo back to only in-person visits.

I think people will want theoption of telehealth visits as well.

Now, they can't replace our entirehealthcare system and people still will need to come in fortheir pap smears and exams.

But I think people willfind a preference for this.

They won't have to take off a dayfrom work or take three buses to travel to the doctor's officeor find childcare.

The system that we were inbefore was not particularly efficient.

There were just massive costs.

And you saw just, you know, that increase every single year.

It just it wasn't sustainable.

Telemedicine for a long time has beena way to bring costs down.

It makes sense.

You should see someof these patients virtually that can be seen that way and then savethe physician time for those that really need that in-person care.

And I think telemedicine offers thatand it's likely where medicine is going.

For doctors the new rulesfor telemedicine and insurance means they stand to make more money from thepractice, if those rules do stick around.

Insurers are also going to havea very hard time clawing back this flexibility withtelemedicine payments.

And so it's also going to be mucheasier for physicians to get paid for their time and have a viablebusiness model providing care across the whole spectrum.

The coronavirus pandemic createda clear line between the before and after for thewider health care industry.

And telemedicine might be a bigpart of what comes after Covid-19.

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