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Telehealth: Now and for the Future

Evan Winter

Many businesses and entire industries have had to adapt in 2020, and healthcare is no exception. With much of the American population sheltering in place last spring and continued social distancing, the practice of telehealth, or telemedicine, has exploded. So much so, that at the end of May, a McKinsey & Company report stated that providers were “seeing 50 to 175 times the number of patients via telehealth than they did before.” Additionally, a recent UnitedHealth Group survey showed that over a quarter of participants actually preferred virtual relationships with their primary care providers. We know the COVID-19 pandemic has dramatically increased the need for telehealth, but what has allowed such practices to move forward so quickly, and what are the benefits or drawbacks of such a rapid shift? 

The recent changes

The American Medical Association describes telemedicine as being “Real-time, audio-video communication tools that connect physicians and patients in different locations.” These services often include the use of digital scales, blood pressure cuffs, thermometers, and other tools in the patient’s possession to report biometric data. It should also be noted that most providers do not consider audio-only or written communication with patients to be telemedicine or telehealth. When orders to shelter in place came last March, there were a few important systematic changes that allowed relatively sudden, widespread telehealth implementation. For one, Federal regulations loosened, allowing physicians to see patients via video chats without a previous HIPAA agreement with whatever technology vendor they were using. Also, effective on March 6, Medicare began paying for telehealth services in an equal fashion to in-person visits, regardless of the treatment’s relation to COVID-19. Many states started requiring health insurance companies to do the same. Not least of all, the vast majority of states reduced license requirements, allowing clinicians to practice remotely across state lines. These abrupt changes provided immediate solutions in a state of emergency and an array of other benefits, but what is working in the short term may need to be revised for sustainability.

Benefits of expansion

The rewards of widespread telehealth are numerous, even beyond slowing the spread of COVID-19. Physicians visiting remotely with patients saves both parties trips to an office, which may be unneeded for preventative care, initial evaluations, follow-up visits, or post-hospitalization monitoring. The ability to see a doctor from home can also eliminate the guesswork sometimes involved when deciding whether to visit the emergency room or not. Perhaps most of all, telehealth is a game-changer for patients with chronic diseases. These patients can send medical data, such as blood pressure or blood sugar, to a doctor who is then able to monitor the patient’s condition remotely and on a more consistent basis. 

Potential problems

Despite all the benefits, there are some pitfalls related to moving forward with telehealth so quickly, and those must be discussed. Regulations changing practically overnight were essential under the weight of a pandemic, but the changes are not necessarily dependable in the long run. It will likely soon become a requirement for clinicians to have HIPAA agreements in place with tech companies. The current technology landscape is extremely broad and unregulated as it is, and patient privacy and general information security will be major concerns with telehealth. It is also unlikely that Medicare and health insurance companies will continue to reimburse telehealth visits across the board once the national state of emergency has worn off and individual states no longer explicitly require companies to do so. Pushback, or some greater discussion of what will or will not be covered, is inevitable. At the state level, medical boards will want to protect their respective providers, economically, so allowing all to effectively practice in other states will not be sustainable without restrictions. Perhaps some states will enter a sort of regional partnership to avoid stepping on each other's toes. Then there remain more practice-specific decisions about how care should be delivered. The most pressing being: what types of care can and cannot be delivered via telehealth? When does a patient need to visit a practice in-person as opposed to making a call? The system must also ensure that both practices and patients have reliable telehealth equipment and access to Internet services. If this is not addressed, some portions of the population will see a significant increase in healthcare availability, while others are left farther and farther behind. 

Ensuring the future

This year’s telehealth boom has been amazing in so many ways. Telehealth has allowed a large portion of the population to continue primary care visits on possibly a more regular basis than before the COVID-19 pandemic. Not only that, but those patients are able to stay home and avoid the in-person contact which may place them in harm’s way. In a few months, the pandemic has caused telehealth implementation to leap forward a distance that may have otherwise taken years. Some growing pains from such a shift may have yet to catch up with the industry, but continuing the conversation surrounding telehealth practices is essential to making sure advancements are here to stay.