Fad or future? Telehealth growth eyed past pandemic

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Fad or future? Telehealth expansion eyed beyond pandemic

In this Aug. 24, 2020 photo, Jean Grady smiles as she walks into her Westford, Vt. Grady, posing. She wears an insulin pump to treat her diabetes. Prior to the pandemic, Medicare rules required them to make regular two-hour, one-way trips to New Hampshire to meet with their doctor and discuss their treatment. Changes to Medicare rules during the pandemic now allow her to meet her doctor remotely, eliminating the need to spend hours on the road. (AP Photo / Wilson Ring)

Telehealth is a bit of American ingenuity that seems to have paid off in the coronavirus pandemic. Medicare temporarily waived restrictions before the smartphone era, and now attempts are being made to make telemedicine widely available in the future.

Consultations on tablets, laptops and phones connected patients and doctors when the Society closed in the spring. Telemedicine visits decreased with the reopening, but they are still far more common than before.

To extend access permanently, a balance needs to be struck between cost and quality, privacy concerns and potential fraud must be addressed, and how telemedicine can reach marginalized patients, including people with mental health problems.

"I don't think this will ever replace face-to-face visits as sometimes a doctor has to lay hands on a patient," said Seema Verma, director of the Centers for Medicare and Medicaid and lead Trump administration attorney on telehealth.

Aside from the caveats, "it's almost a modern home visit," she added.

"It's fair to say that telemedicine was in its infancy before the pandemic, but it has come of age this year," said Murray Aitken of data firm IQVIA, which is tracking the impact.

In the depths of the coronavirus shutdown, telehealth made up more than 40% of primary care visits for traditional Medicare patients, compared to a tiny 0.1% pre-public health emergency. As the flagship of the government's health program, Medicare covers more than 60 million people, including those 65 and over and younger disabled people.

A recent survey of older adults conducted by the University of Michigan's Department of Health Policy and Innovation found that more than 7 in 10 are interested in using telemedicine for follow-up visits with their doctor, and nearly 2 in 3 are comfortable with video conferencing.

Fad or Future? Extending Telehealth beyond the pandemic
In this Aug. 24, 2020 photo, Jean Grady wears an insulin pump to manage her diabetes at her home in Westford, Vt. To treat. Prior to the pandemic, Medicare rules required them to make regular two-hour, one-way trips to New Hampshire to meet with their doctor to discuss their treatment. Changes to Medicare rules during the pandemic now allow her to meet with her doctor remotely, eliminating the need to spend hours on the road. (AP Photo / Wilson Ring)

However, privacy was an issue, especially for those who hadn't tried telemedicine. The survey found that 27% of older adults who haven't had a telemedicine visit were concerned about privacy, compared to 17% of those who tried.

Those who tried telemedicine were not fully sold. About 4 out of 5 were concerned that the doctor could not physically examine them, and 64% feared the quality would not be as good.

"After the initial excitement in the afterglow, patients find that I can't get my vaccine or that they can't see this thing through the computer in my throat," said Dr. Gary LeRoy of Dayton, Ohio, family doctor and President of the American Academy of Family Physicians.

For Medicare beneficiary Jean Grady of Westford, Vermont, telemedicine was a relief. She needed a Medicare-required exam to continue getting supplies for her portable insulin pump. Grady was in a high risk group for COVID-19 and was concerned about possible exposure in a doctor's waiting room and even more concerned about losing her diabetes care if she missed the Medicare check-up deadline.

"I should have taken insulin with a syringe again," she said.

Grady prepared for the virtual visit by calling her clinician's technical department and downloading conference call software. She says she would make some future video visits, but not all. For example, people with diabetes need regular blood tests and their feet need to be checked for signs of circulatory problems.

Still, some follow-up exams "could be done very efficiently and as useful to the doctor and me as seeing them in person," Grady said.

Many private insurance plans, including the one in Medicare Advantage, offer some level of telemedicine coverage.

Fad or Future? Extending Telehealth beyond the pandemic
In this August 24, 2020 photo photo, Jean Grady holds her insulin pump, which is used to treat her diabetes, at her home in Westford, Vt. Prior to the pandemic, Medicare rules required them to make regular two-hour one-way trips to New Hampshire to meet with their doctor to discuss their treatment. Changes to Medicare rules during the pandemic now allow her to meet her doctor remotely, eliminating the need to spend hours on the road. (AP Photo / Wilson Ring)

However, traditional Medicare has restricted it to rural residents who generally had to travel to specially designated locations to connect.

As part of the coronavirus public health emergency, the administration temporarily waived Medicare restrictions to allow attendees to use telemedicine anywhere. Patients could connect from home. Legislation from Congress would be required to make such changes permanent, but there is a bipartisan interest.

Senator Lamar Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, wants wider access without breaking the bank.

"Our job should be to make sure that changes that drive better outcomes and better patient experiences are made at a lower cost," said Alexander, R-Tenn.

It's a big job.

Payment will be a sticky barrier. Medicare currently pays doctors for virtual and face-to-face visits.

"Policymakers seem to be in a hurry to get legislation passed, but I think it's worth taking a little more time," said Juliette Cubanski, Medicare expert at the non-partisan Kaiser Family Foundation. "Fraud is a huge area that policy makers need to be aware of."

Scammers agree.

Fad or Future? Extending Telehealth beyond the pandemic
In this Aug. 24, 2020 photo, Jean Grady wears an insulin pump to manage her diabetes at her home in Westford, Vt. To treat. Prior to the pandemic, Medicare rules required them to make regular two-hour, one-way trips to New Hampshire to meet with their doctor to discuss their treatment. Changes to Medicare rules during the pandemic now allow her to meet with her doctor remotely, eliminating the need to spend hours on the road. (AP Photo / Wilson Ring)

Telehealth is so new that "right now we don't know exactly what the enormous risks are," said Andrew VanLandingham, senior attorney with the Inspectorate General for Health and Human Services. "We are in an experimental phase."

Proponents see opportunities despite the risks.

Medicare advanced telehealth could:

– Help the nation move closer to a long-awaited goal of treating mental health as it does physical. Senator Ron Wyden, D-Ore., Wishes to use telemedicine as a stepping stone to improving mental health. IQVIA data shows that 60% of psychiatric consultations during shutdown were via telemedicine.

– Improving access for people living in remote communities, in low-income urban areas and even in nursing homes. Medicare research shows that low-income beneficiaries had similar patterns of using telemedicine for primary care as program participants overall.

– Improving the coordination of care for people with chronic diseases, an objective that requires patient and continuous monitoring. Chronic care makes up most of the program spending.

Mark Fendrick, a health policy expert at the University of Michigan, says Medicare should identify and pay only for what services add value to patient health and taxpayer wallets.

Telehealth "was an overnight sensation," said Fendrick. "Hopefully it's not a one-hit miracle."

Telehealth visits have skyrocketed for older adults, but some concerns and barriers remain

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