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Telehealth: Is it here to stay?

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The numbers say it all: Before the COVID-19 pandemic, less than 1 percent of health assessments were conducted virtually, according to the Arlington, Va.-based American Telemedicine Association.

Then came the shutdown. 

By mid-April, about 50 percent of health assessments were done virtually. Today, it’s flattened out to 15 to 20 percent, which is about the number that Kyle Zebley, the association’s director of public policy, thinks we’ll see as the pandemic eases.

“It’ll stay in that range if policymakers make that possible by lifting regulatory hurdles,” said Zebley. “Telemedicine has come of age as reimbursement rates have risen significantly and the regulatory barriers we’ve long wanted abolished have been.”

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Those barriers only lifted due to a worldwide health crisis. Zebley fears the number will snap back to almost nothing as soon as the pandemic ends “unless state and federal policymakers act.”

Flexibility

While telemedicine can work well “not everything is appropriate for telehealth,” said Zebley. “For instance, it’s good for mental health and normal primary care visits that can be done without in-person contact, but then there are still dental visits, physicals and surgery. However, many visits can be, and remain, virtual.”

He added, “Many people like the flexibility telemedicine offers and the ability to still understand diagnosis and treatment discussed and the quality outcomes. I think it’s evident that telehealth has saved the health care system from collapse because it offered, during the peak of the shutdown, access to non-emergency but needed services.”

Dr. Brian Hasselfeld, medical director, digital health and telemedicine with the Office of Johns Hopkins Physicians, noted the sudden market shift.

“Across Johns Hopkins Medicine throughout the COVID-19 pandemic, total telemedicine visits increased more than 1,000 times during the peak months of April and May, reaching more than 90,000 total visits in these months,” said Hasselfeld. “This represented more than half of our total care across the system.”

A similar trend was seen at Hopkins-affiliated practices in Howard County, with telemedicine appointments “going from a handful of visits per month to more than 3,500 visits in our peak months,” Hasselfeld said.

After the re-opening progressed across the state, there has been transition back to in-person care. “But overall,” he said, “telemedicine care has remained more than 25 percent of our ambulatory care and in many areas remained more than 50 percent of ambulatory care.”

New Service

Hopkins recently surveyed more than 50,000 patients after their telemedicine visits and they reported “high satisfaction” with providers, Hasselfeld said.

“We’re seeing early signs that our providers and patients will be looking to continue telemedicine after the pandemic, and Johns Hopkins Medicine will continue to work on increasing access to telemedicine care,” he said, “as well as launching new technologies for accessing our providers.”

At Kaiser Permanente, spokesperson Betty Klinck said telehealth visits “increased from about 15 percent of all visits before the pandemic to nearly 90 percent this past spring.”

While that number has leveled off to about “50 percent in recent months as our members feel more comfortable coming in for care,” she said. Kaiser executives believe that number will remain on the higher end.

The recent telehealth numbers have resulted in Kaiser rolling out a new product, Virtual Forward, which will allow its members access to unlimited virtual appointments with more than  1,600 primary care and specialists who work together in a coordinated system, in addition to accessing in-person options for a fee.

“This new option will cover annual health check-ups and screenings at no cost,” Klinck said. “The four new Virtual Forward plans will offer convenient, more cost-effective product for consumers who want virtual access first, with an option for in-person care across the region.”

‘What It’s About’

The main reason for the telehealth boom is simply that it had to happen.

While a sizeable sector of the market would have welcomed it pre-pandemic, “there were so many barriers to using it on the federal and state fronts that it never had a real chance to gain any traction,” said Jennifer Witten, vice president, government affairs for the Elkridge-based Maryland Hospital Association.

“It never reached the point where health care providers could use it to deliver services, have the appropriate technology to use and handle reimbursements while negotiating a mishmash of polices and other considerations,” said Witten, “but the pandemic, fortunately or unfortunately, has forced governments to allow it and take advantage of the its benefits.”

There were also plenty of occasions when telehealth appointments were handled not over the computer or tablet “but via telephone in rural areas, underserved communities and by seniors who may not be technologically savvy or have access,” she said.

What’s needed next, Witten said, is legislation to continue the broad acceptance of telehealth “to get the provisions we need to preserve this flexibility. We’ll also need better direction from the Centers for Medicare and Medicaid Services regarding what Medicare will continue to cover and reimburse.”

She said, “What this really about is about giving consumers what they want.”

By Mark R. Smith | Senior Writer | The Business Monthly | December 2020 Issue

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