Considering the eagerness with which the health care industry embraced telemedicine as COVID-19 started circling the world, it may seem surprising that lately, physicians have been less enthused than they were earlier in the pandemic. Initially, physicians and industry watchers predicted the widespread adoption of telemedicine as a permanent aspect of primary care. However, a recent report reveals an unexpected trend: In one large health care company, telemedicine usage has been falling steadily since late April. What happened to the early enthusiasm?
The data assembled and analyzed by Harvard University researchers in conjunction with Phreesia, a health care technology company whose clientele includes over 50,000 physicians, shows that early in the COVID-19 pandemic, the combination of a lockdown and stay-at-home orders forced providers and patients to use telemedicine visits as an alternative to in-person visits. Now, though, the initial panic has passed; COVID-19 still poses a considerable threat to public health, but it’s not an apocalypse. With this extra breathing room, many health care organizations have begun to evaluate the long-term value of adding telemedicine to their practices—and not everyone likes what they see. Their hesitation revolves mainly around the uncertain future of financial sustainability, with additional challenges in the forms of reliability and user friendliness.
Earlier this year, in a response to the COVID-19 threat, legislators expanded reimbursements for telemedicine and eased restrictions on the need for privacy and security as outlined by the Health Insurance Portability and Accountability Act (HIPAA). The removal of such obstructions, such as the allowance for a patient’s home to qualify as an originating site, has significantly improved access to care via telemedicine for all patients, rather than a few select groups favored by Medicare’s previous regulations. In addition, many commercial insurers agreed to reimburse providers for telemedicine visits—a turnaround from their previous unforgiving stance regarding the legitimacy of telemedicine consults. These changes opened the floodgates for health care providers to quickly adopt ready-made telemedicine packages and expand existing programs within their facilities. As a result, telemedicine usage grew exponentially during the first quarter of 2020.
With such an enthusiastic response from both patients and physicians, telemedicine proponents have extolled the virtues of making this technology a permanent part of a physician’s practice after the pandemic ends. The current emergency measures have indeed proven helpful, but if the telemedicine regulations and reimbursement plans return to their pre-pandemic levels, many providers—especially smaller, private clinics—will be stymied by the sudden dearth of financial and other supports. Without fore-knowledge of the future of telemedicine regulations and reimbursement, many providers are wary of delving heavily in new systems and workflows; there is no guarantee that the up-front capital investment of these changes will be recovered through future reimbursements.
Adding to providers’ concerns, the very act of adding the technology to their practices often turns into a tangle of selecting the appropriate hardware and software, training staff and patients on its use, updating clinical schedules, and redesigning workflows. Setting up a solid program requires resources and expertise, which are typically more available to larger organizations. Indeed, organizations with more than 100 clinicians have reported a usage rate twice as high as that of smaller groups with five or fewer clinicians.
Finally, patients using telemedicine for the first time encountered their own issues. Learning how to use a new system can be challenging and frustrating amidst a health crisis; the lack of reliable, fast internet access due to poor infrastructure or congested networks only compounds the problem. In many cases, technology problems with video visits—for the patient, provider, or both—drove physicians to revert to telephone calls.
The researchers suggest that telemedicine can still become an integral part of the primary care experience, but only if pro-telemedicine regulations and reimbursements are allowed to continue beyond the pandemic. If both patients and doctors are willing to transition to telemedicine for convenience and social distancing, then now is the time to take proactive steps to encourage providers to use this tool permanently. Government agencies and private insurers need to determine their long-term plans now; only then, with credible information, will clinicians be able to make solid decisions regarding the value of investing in a more lasting form of the technology.