Telemedicine took off during the Covid pandemic. My dog’s veterinarian began requiring Zoom calls for annual visits. To this day she sees most of her established patients over Zoom. During the Pandemic telemedicine startups sprang up to take advantage of heightened demand. TelaDoc’s stock shot up to the stratosphere, as did the market capitalization of many telemedicine firms. Anxiety and depression increased during the lockdowns when many families were forced to work from home and schools only taught over Zoom. As a result, behavioral health remote counseling apps and counseling services sprang up as well.
During Covid Congress began to allow regulatory flexibility for Medicare to reimburse telemedicine. Many doctor’s offices were closed. Many (if not most) of the doctors I knew would not treat Covid patients in the early stages of the pandemic. Many doctors would not even allow patients into their offices lest a patient with Covid make other patients and staff sick. Yet, seniors needed to see their doctors and the safest way was by phone.
Regulatory flexibility for Medicare to cover telemedicine is set to expire at the end of the year unless Congress acts quickly. Many experts are fully committed to telemedicine while others think the benefits have been exaggerated. This from National Review (gated):
Telehealth — the use of remote audio or video technologies to provide health-care services — has been promoted as a way to increase patients’ access to care particularly in rural and underserved areas, increase convenience to patients, improve quality, and decrease costs relative to traditional in-person care. But there is little evidence to support these claims.
Prior to the Covid Pandemic, less than 1% of office visits were delivered remotely. Telemedicine shot up offsetting the drop in in-person office visits but according to National Review, in-person and telemedicine visits have since stabilized back to pre-pandemic levels. One bright spot is that mental health and substance abuse counseling by telephone rose during Covid and remain higher than prior to Covid. Those types of services require little in the way of an in-person examination. Yet, contrary to what experts expected telemedicine use was higher in urban areas than rural areas, the exception being behavior telemedicine consults.
Not necessarily mentioned in the National Review article, telemedicine is better for some patients than others. As one would expect, telemedicine is better for some conditions than others. It is probably better (or worse) for some doctors than others. More from National Review:
Telehealth is likely no worse than in-person quality in most other medical areas, particularly when used for follow-up visits of established patients rather than for initial consultations. Several studies, however, reported troubling overprescription of antibiotics for inappropriate indications at telehealth visits, a practice which could exacerbate the growing problem of antibiotic resistance. And many physicians believed that in-person visits offered a better personal connection and improved physician–patient relationship compared with telehealth. [emphasis mine]
The previous sentence makes an interesting point. My wife and I have noticed that in-person visits tend to last longer, and the provider more attentive due to the face-to-face connection. My wife especially noticed that are addressed during in-person meetings, that were previously dismissed over telemedicine. Perhaps it’s harder to end the consultation in person than on the phone.
According to a new study the questions still remain whether or not telemedicine increases or decreases medical expenditures. It is not clear whether telemedicine replaces in-office visits or adds to total visits. Telemedicine likely offsets in-person visits but could easily increase total visits to the extent access to care is increased. Whether any potential increase in total visits is good or bad is also an issue that is not yet solved. The author of the study recommends Congress proceed with caution and make any extensions temporary while the administration assesses the quality and efficiency of telemedicine in the Medicare program.
Telemedicine is popular among those who use it, but it’s not necessarily great in all circumstances. Probably the greatest weakness is how it’s reimbursed. If patients pay their own physician bills, they are free to choose which service works best for them. When third parties reimburse for physician consults, there is always the risk that telemedicine visits provide little in the way of value. As is often the case with articles, the comments to the National Review article provide a range of interesting observations on telemedicine.