2020 has been a difficult year, but despite all the pain and uncertainty, there are still signs of hope for a brighter future. This week, Frontier Group analysts share stories of the societal changes, technologies and movements that inspire us.
Before the arrival of the novel coronavirus, telemedicine – allowing patients to have contact with a health care provider over a web interface or via a phone call instead of through a face-to-face appointment – was not widely used. Insurers and government health programs severely limited the circumstances in which they would pay for a virtual visit, and relatively few providers had figured out the logistics of offering telemedicine.
That changed abruptly when the risk of contracting COVID-19 caused people to avoid as many in-person interactions as possible, including trips to the doctor, therapist or other health care provider. Almost immediately, the federal government and private insurers expanded their coverage, providers adjusted their practices, and patients began using telemedicine.
Though we all eagerly await the day when it is safe to have dinner with friends, send our kids to school and grocery shop without a mask, we don’t necessarily want to return to a world in which every interaction with a health care provider has to be in person. The nation’s health care system will work better for patients by maintaining the expanded access to telemedicine forced upon us by the coronavirus.
Telemedicine visits have increased dramatically since the start of the pandemic. For example, before the pandemic, 13,000 Medicare recipients received care through a telemedicine visit each week. That had grown to 1.7 million Medicare patients by the last week of April. Telemedicine visits were especially common for routine matters that might have been covered in an office visit and for mental health issues. More than one-third of Medicare beneficiaries who had an “office visit” did so via telemedicine, and 60 percent of behavioral health visits were virtual.
Medicare data shows that patients from a variety of backgrounds have embraced telemedicine. 30 percent of urban Medicare patients used telemedicine, compared to 22 percent of rural beneficiaries. Men and women had telemedicine appointments at nearly the same rate. Age didn’t affect use: Of patients ages 65-74, 25 percent used telemedicine, while 29 percent of beneficiaries ages 75-84 did. Telemedicine use didn’t vary significantly by race or ethnic group, either. And low-income patients who qualify for Medicaid in addition to Medicare used telemedicine at a higher rate than Medicare-only patients.
Patients are willing to use telemedicine at such high rates because it delivers multiple benefits. It can provide easier access to care – no need to drive or ride transit to the provider’s office, or to arrange for child care during that time. If the patient is employed, a telemedicine visit requires less time off from work than an in-person visit would. Removing these logistical barriers can make it easier for patients to receive care, especially for recurring appointments. For example, the no-show rate of patients receiving addiction counseling at one community health center in Northern California fell from 60 percent pre-pandemic to just 11 percent.
Telemedicine has its limitations, of course. Some types of medical care have to be provided in person, such as when a hands-on exam is needed or a patient needs to have their blood pressure checked. Another challenge of telemedicine is that not all patients may be able to access virtual services. Some patients, especially in rural areas, may not have broadband access that can support a video appointment. Others may not have a computer or a phone with a data plan, or may lack the technical skills to feel comfortable with an online appointment. In other cases, the hurdles may not be technological. In crowded housing situations, a patient may not be able to find a sufficiently private location to feel comfortable participating in a telemedicine visit with their doctor. For these and other reasons, telemedicine visits should be available to, but not required of, patients.
Overall, though, both patients and providers have responded favorably to the increased use of telemedicine. According to McKinsey, nearly three-quarters of patients who have had a telemedicine visit report being highly satisfied. More than 75 percent of people surveyed said they were likely to use telemedicine in the future. A majority of providers now have a more favorable view of telemedicine, and two-thirds report that they have grown more comfortable with virtual visits.
For the health care system overall, increased use of telemedicine has the potential to reduce costs. An estimated 20 percent of emergency department visits – those for more minor concerns – could be replaced with telemedicine. On an ongoing basis, care for patients with chronic conditions that require regular check-ups may be less expensive if some care is conducted via virtual visits rather than in-person appointments. However, policymakers will need to guard against potential abuses by providers or insurers that could increase costs for patients, such as higher fees for telemedicine visits than in-person visits.
Both the federal government and states appear to be ready to facilitate the continued use and expansion of telemedicine. The idea has bipartisan support, with the left-leaning Public Policy Institute and the conservative group Americans for Prosperity jointly releasing a set of recommendations for how to permanently increase access to telemedicine.
In early August, President Trump signed an executive order to permanently approve broader access to telemedicine visits for rural Medicare patients. Ensuring continued access to telemedicine for all Medicare enrollees, however, will require congressional action. One congressional analyst expects Congress to act by the end of the year.
States will also need to extend provisions that have allowed Medicaid patients greater access to virtual health care services. Such policies include eased licensing requirements for out-of-state doctors, allowing them to provide telemedicine services across state lines; making telemedicine available to patients who don’t live in rural areas; and including phone calls, not just video calls, in their definition of covered telemedicine services.
While providers may invest in technologies to make virtual visits easier and private insurers may revise their policies to promote the use of telemedicine, policymakers can also ensure this happens. Proposed legislation in Massachusetts, for example, would require insurers to pay for telemedicine visits for primary care, chronic disease management and behavioral health.
The coronavirus pandemic has forced Americans to substitute virtual interactions for many things we’d rather do in-person. Though we’ll eagerly return to classrooms or meals with friends, we’ll be happy to have the option of skipping the long wait at the doctor’s office. Expanded access to telemedicine is one change precipitated by the coronavirus pandemic that has changed our health care system for the better.
Photo: Marcy Sanchez/U.S. Army
Associate Director and Senior Policy Analyst, Frontier Group
Elizabeth Ridlington is associate director and senior policy analyst with Frontier Group. She focuses primarily on global warming, toxics, health care and clean vehicles, and has written dozens of reports on these and other subjects. Elizabeth graduated with honors from Harvard with a degree in government. She joined Frontier Group in 2002. She lives in Northern California with her husband and son.