The Ultimate Guide to Telemedicine in 2021
COVID-19 has changed how we do a lot of things over the past 6 months, and healthcare is no exception. As the pandemic continues, healthcare providers are learning more about how to continue to offer the best care possible while mitigating the risk of spreading disease. A lot of what has been learned has opened the door for potentially permanent changes to the way healthcare is delivered in the USA as providers, insurance companies, and lawmakers realize that there are true benefits to telemedicine beyond making it easier to shelter in place. This guide will talk about what telemedicine is, what the benefits are, and how you can take advantage of this form of care so that you can make the most of these great new developments.
Last Updated: 12/21/20
Disclaimer: This article is for informational purposes only. Please consult a doctor, medical provider or health practitioner about telemedicine and its uses.
What is Telemedicine?
According to the American Academy of Family Physicians (AAFP), telemedicine is “the practice of medicine using technology to deliver care at a distance. A physician in one location uses a telecommunications infrastructure to deliver care to a patient at a distant site.” Plain and simple, telemedicine allows patients to consult or interact with their doctors from wherever they are, without having to show up in person for an appointment.
According to the Centers for Disease Control (CDC), commonly used forms of telemedicine include:
- Video visits with your doctor
- Exchange of messages, chats, and data through online applications
- Remote patient monitoring
What are the Potential Benefits of Telemedicine?
The benefits of telemedicine reach far beyond the current need to promote social distancing:
Potential Increased Convenience and Appointment Attendance
Because telemedicine eliminates the need to travel as well as any costs associated with taking a drive, it is a more convenient way to interact with healthcare providers. The flexibility that is gained from this eliminates some barriers to scheduling appointments, such as a need to avoid taking off time from work. At Children’s Omaha, where many families drive several hours to make it to appointments, no show rates for psychiatry appointments were reduced by 50% when telemedicine was implemented. We all love saving commuting time when we can!
Reports of Improved Patient Outcomes
Telemedicine allows patients and doctors to communicate so that disease can be prevented and health issues can be treated before they become a big problem. In terms of preventive care, a meta-analysis in the British Medical Journal (BMJ) saw a reduction in heart failure patient hospital stays and mortality rates when receiving preventive care through telemedicine. As for an emergency scenario, telemedicine resulted in an increased use of life saving drug alteplase within 60 minutes of a stroke patient being admitted into a hospital, according to the CDC. Additionally, the CDC mentions a rural telemedicine diabetes management program in Montana that resulted in increased patient participation. Double the participants (61%) checked their blood sugar regularly and over 3 times as many participants said they were following a proper diet after 6 months of the program. These improved outcomes are clearly being seen in a variety of healthcare situations.
Reaching People in Who Have Less Access to Healthcare
As of December 2018, there were over 7,000 health professional shortage areas in the US, over 60% of these areas being rural. As hospitals continue to shut down, filling these vacancies continues to be a challenge – only 2% of students in their last year of medical school have a desire to live in a town with a population of fewer than 25,000. In situations where a drive to the nearest hospital becomes a challenge or time suck, telemedicine can help connect patients with their physicians to discuss health issues and get questions answered, and provide the aforementioned benefits of telemedicine.
Many people with disabilities also have challenges getting to appointments, whether it be due to issues scheduling proper transportation, anxiety, or lack of an available caregiver. Telemedicine also saves these patients a trip to the hospital that may not even be possible for them to coordinate.
Changing Policy and Attitudes Around Telemedicine
Before the pandemic, it wasn’t so easy to swap a car ride to the doctor’s office for an evisit over Zoom. This is due to a variety of factors – including laws and insurance coverage barriers, as well as physician attitudes. Since the pandemic, McKinsey has noted a whopping 50-175 fold increase in patients seen via telemedicine. Clearly, there was a lot of room for growth.
Laws Affecting the Adoption of Telemedicine
While the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has allowed the use of telemedicine through platforms compliant to patient security standards such as Updox and VSee, providers have been slow to adopt. A poll by one telemedicine provider recently showed that just 23% of providers were offering virtual visits to patients, but a much smaller 6% of patients are aware that their provider offers such a thing.
Because of the pandemic, the many healthcare providers who did not previously offer telehealth services needed to scramble for a way to provide these services to patients. To make is easier to solve this problem faster in these trying times, the US Department of Health and Human Services and Office for Civil Rights (OCR) announced that while the pandemic continues, providers have the option of using non-public facing communication tools in good faith that don’t fall under the list of what is HIPAA compliant – i.e. Zoom, Skype, and Facebook Messenger Video Chat. These services can be used for patients with any condition – related to COVID-19 or not, if they are an appropriate way to provide care in the situation, as any reduction in in person visits helps reduce the risk of the virus spreading.
Insurance Policies Affecting the Adoption of Telemedicine
Additionally, the Centers for Medicare & Medicaid Services (CMS) relaxed some of their previous restrictions on telehealth which has made its rise in use much easier. These changes include:
- Patients being able to receive telemedicine services from doctors they haven’t previously seen. Before the pandemic, one could only receive telemedicine services from a provider who they had already seen in person.
- Physicians can now see patients in states where they are not licensed through telemedicine.
Medicare will pay physicians the same amount for telemedicine services that they do for in-person services as long as the pandemic persists. States can determine whether Medicaid will do the same. The benefits of requiring payment to doctors offering telehealth services are not new. A 2018 study of telehealth services in states from 2010 to 2015 showed that patients in a state where laws required insurers to reimburse for some telehealth coverage were 30% more likely to have received telemedicine.
A Possible Shift in Physicians’ Attitudes Toward Telemedicine
Attitudes toward telemedicine’s advantages among physicians have been changing, though slowly. An American Medical Association (AMA) report released right before the pandemic showed that between 2016 and 2019, there was a five percent increase in the percentage of physicians seeing definite value in telemedicine, bringing the total seeing a definite benefit to 36%. Though a majority of physicians may still not be seeing these benefits loud and clear, their adoption of telemedicine tools grew significantly over this three year period. The percentage of physicians offering televisits doubled from 14% to 28% – still a minority were utilizing these services but that is a lot of growth! Use of other digital health tools grew as well – including remote monitoring tools, clinical decision support, patient engagement, and more. In 2019, about half of physicians were using point of care enhancement, and 58% were utilizing consumer access to clinical data.
Doctors adopting these tools are primarily motivated by the ability to provide remote care, allocate staff resources, and see more patients. Patient demand, practice differentiation, and the addition of a new revenue stream have not been quite as strong motivators. Physicians in 2016 saw providing remote care as a niche need, but in 2019 saw it as a key motivator for adoption of digital tools. Reducing burnout was also noted to be an area causing more enthusiasm among physicians to adopt these tools.
Will Telemedicine Continue to be Easy to Access after the Pandemic is Over?
There are a lot of questions that need to be addressed before the future of telemedicine is set in stone. What we do know so far is that COVID has increased demand for telemedicine services. According to McKinsey, just 11% of patients were receiving telemedicine care before the pandemic – now 76% of patients want to continue using these services.
As exciting as these changes in outlooks are – a lot more has to happen to make telemedicine a permanent part of standard of care. The lifting of restrictions that has allowed for increased use of telemedicine is in many instances not permanent, which means changes to the law are required to keep things going. Issues such as reimbursement from insurance fuel concern among providers – telemedicine cannot move forward until insurance companies are reimbursing telemedicine appointments at the rates that they reimburse regular appointments. Pre-COVID, all states required that some reimbursement was provided, but most often total parity was not required so there was no good financial incentive to go virtual for most physicians.
Physicians are seeing the value of telemedicine though – 57% of doctors are more enthused by telemedicine than they were pre-pandemic, and 64% are more comfortable utilizing it. However, physicians need to more than just see the value of telemedicine. Once the relaxations of HIPAA policy are taken away, they will need to invest in secure systems and platforms in order to continue to deliver virtual services through their practices.
An additional challenge is that Medicare has historically offered very limited coverage of telemedicine, due to congressional concern that patients will use more services and drive up costs.
When these barriers are addressed on a more permanent level, telemedicine use can become more widespread for good.
How Can I Take Advantage of Telemedicine?
Using telemedicine is typically simple and guided by your provider, who will have standard platforms and apps that they use to provide their services. Talk to your Dr. about whether or not you can have a virtual appointment – likely in these times they are ahead of the game and will give you the option first. They can instruct you on what you need to do to communicate with them through apps or log on for a video session. If your doctor is not providing you this option, ask why. The more professionals are aware that patients demand these services, the more incentivized they will be to utilize them.
Resources on How to Use Telehealth
Resources for Tracking Telemedicine Policy
Note that these policies may not reflect the current COVID exceptions.