Telemedicine shines during pandemic but will glow fade?

Racked with anxiety, Lauren Shell needed to talk to her cancer doctor.

But she lives at least an hour away and it was the middle of her workday. It was also the middle of a pandemic. Enter telemedicine.

The 34-year-old Leominster, Massachusetts, resident arranged a quick video visit through the app Zoom in May with her doctor in Boston. He reassured her that he was confident in their treatment plan, and the chances of her breast cancer returning were low.

“It was really great to be able to talk to him about what I was feeling,” she said. She felt comforted afterward “knowing that I wasn’t alone.”

This is how doctors and health care researchers envision telemedicine evolving after the COVID-19 pandemic fades. They see the practice — which has grown explosively this year — sticking around to replace many in-person visits and become a greater part of routine care.

Imagine more contact with doctors or nurses but fewer trips to the office. Patients might use telemedicine more for check-ins like Shell did or to talk to a doctor after a procedure or get a second opinion. There's also secure messaging for quick questions and more remote monitoring of chronic health problems like diabetes.

“Your care is going to get better,” said Dr. Thomas Lee, a Harvard professor and care delivery expert with the health care consultant Press Ganey.

But to keep some of telemedicine's growth, thorny questions about insurance coverage and doctor reimbursement need to be resolved.

Plus, patients and doctors who were forced to try virtual care during the pandemic need to keep using it.

Doctors scrambled to shift to telemedicine when the coronavirus hit the U.S earlier this year. Care providers like the Cleveland Clinic went from averaging 5,000 telemedicine visits a month before the pandemic to 200,000 visits just in April.

Many insurers waived fees to encourage its use. The federal government relaxed restrictions on telemedicine's use in Medicare, the federal coverage program for people age 65 and over. The government also started temporarily allowing visits over apps that didn’t meet patient privacy standards.

That helped Dr. Jay Meizlish connect with his mostly older heart patients. At first, they struggled. He often had to hold cards up to his camera, telling patients to unmute their microphone or turn up their volume.

Then he found what worked — he switched to the more familiar and easier to use FaceTime.

“That’s how they talk to their grandchildren,” the Yale New Haven Hospital doctor said.

“We have learned the power of this, but whether it continues is not in our hands,” he said.

Experts expect some telemedicine restrictions will return, including fees that are now waived. And some doctor practices will be reluctant to work telemedicine permanently into their practices until they know exactly how they get paid, noted John League, a senior consultant with Advisory Board, which researches health care strategy.

“They have no appetite for uncertainty,” he said.

Insurers ultimately will cover more remote care because it can help keep people out of expensive hospitals and emergency rooms, said Arielle Trzcinski, a senior analyst with Forrester, which does research for insurers and hospitals, among other clients.

The insurer Oscar recently announced that it will offer free primary care visits through telemedicine in coverage that starts next year. Leaders in Washington also are interested in expanding telemedicine’s use in Medicare.

Trzcinski also thinks doctor groups will provide more virtual care because patients who tried it during the pandemic may go elsewhere if they don't. With travel and time in the waiting room, an office visit can carve more than an hour and a half out of someone's day on average, she said.

“People value time," she said.

She estimates that virtual care could eventually replace up to 40% of in-person doctor visits that don't involve hospital stays.

Shell, the cancer patient, said she never would have been able to visit her doctor in person that day. She teaches veterinary science at a vocational high school. That makes it hard to break away for an in-person doctor’s appointment.

She wound up using telemedicine a few times because of the pandemic. She hopes the practice continues.

“I feel strongly that increased safety, convenience, and accessibility are all reasons to continue,” she said.

Researchers don’t expect telemedicine to replace all in-person care. Millions of people don’t have access to the technology or a reliable internet connection. Some people may still be reluctant to use it.

And not all ailments can be treated remotely.

Alexandra Thomas tried it last spring when she woke up with vertigo that made her so dizzy she could barely walk. The nurse practitioner handling her virtual visit wanted Thomas to see someone in person. That meant the 24-year-old Charlottesville, Virginia, resident had to spend another $30 on a copayment and wait three more hours at a clinic before finally getting treated.

Telemedicine, Thomas said, is "a good idea in theory, but maybe not so much in practice.”

Doctors see it playing a larger role for people with chronic conditions. More patients with diabetes may get their blood sugar monitored at home, go to a lab for blood draws and then visit their doctor once a year instead of every three to six months.

Lee, the Harvard professor, said doctors are shifting to caring for patients as efficiently as possible. The pandemic accelerated this push.

"I just think there’s no going back,” he said.

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Follow Tom Murphy on Twitter: @thpmurphy

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