Will doctor’s visits ever be the same again after COVID-19?

Because of stay-at-home and lockdown orders, many patients are now seeing their doctors simply by opening up their laptops and turning on their computers. But, when things go back to normal, will doctor’s visits go back to normal, too (where normal means in-person visits in the doctor’s office)? Or, has telemedicine changed healthcare delivery permanently? 

[For this article, we’ll consider telemedicine, telehealth, and virtual visits to all be the same thing.]

How did we get here? 

For many years, telemedicine has been an understudy waiting in the wings but never called to center stage. But, telemedicine certainly has the spotlight now. 

Before the COVID-19 outbreak, healthcare providers used telehealth for very few types of low-level care, like diabetic teaching and physical therapy, Stephen A. Morgan, MD, senior vice president and chief medical information officer, Health Analytics and Clinical Informatics, Carilion Clinic, Roanoke, VA, told MDLinx. 

Why has telemedicine been on the fringes of healthcare delivery? Because, up until recently, health plans would rarely pay for it. 

The crack that opened the virtual floodgates came in mid-March when the Centers for Medicare & Medicaid Services (CMS) expanded coverage for Medicare telemedicine services nationwide. The CMS announced that telemedicine visits are now equivalent to in-person visits, so virtual visits could be paid at the same rate as regular in-person visits.

At that time, patient visits had dwindled to a trickle in many practices. In a recent MDLinx survey, two-thirds of physicians said that their in-office patient visits had dropped by 50% or more. This figure included about one-third of physicians who had lost more than 75% of all their patient visits.

A virtual explosion

When the CMS gave the green light to telehealth, “everyone had to scale it up from only a handful of patients who would do that, to now having to make it available to every patient,” Dr. Morgan said. 

“Carilion has moved from seeing approximately 10 virtual visits per day to over 4,000 virtual visits per day,” he added. “Eighty percent of our current ambulatory visits are now virtual.”

Data from the American Telemedicine Association (ATA) show that other hospitals and health networks have had similar explosions in virtual visits: 

• At Nemours Children’s Health System, Jacksonville, FL, telemedicine visits rose 1,110% in a single week.

• At Massachusetts General Hospital, Boston, MA, telemedicine visits skyrocketed 10- to 20-fold within weeks.

• At NYU Langone Health, New York, NY, telemedicine went from zero visits to 5,500 visits in a single day.  

Adoption of telemedicine was spurred on by authorities like New York Governor Andrew Cuomo, who urged patients to use it instead of going into clinics and hospitals, where they could potentially spread the virus. 

“We are encouraging people to use telemedicine,” Gov. Cuomo said last month. “[T]elemedicine—where they can diagnose your symptoms, you can speak with a health care professional—that is the best way for an individual’s own health as well as the most beneficial for our overall community.”

Benefits of virtual care

“The biggest benefit of telehealth right now, during the COVID pandemic, has been the ability to stay in contact with patients, to be able to have the continuity [of care], and to be able to treat patients with good quality treatment,” Dr. Morgan said. He added that it has enabled providers to treat patients with chronic disease and, in some cases, those with acute disease. 

The second benefit of telemedicine is almost as important as the first, Dr. Morgan noted. “[W]e’ve been able to keep people out of offices, do social distancing, and minimize the risk if they would have come into the office or come into the hospital,” he said. 

Drawbacks of the telemedicine boom

Although Dr. Morgan has long been an advocate of telemedicine, he concedes that there have been some growing pains in rapidly ramping up these services. 

“[Billing] has been very difficult because the payers haven’t kept up because it’s happened so quickly,” he said. 

Before the COVID-19 crisis, payment for telemedicine wasn’t on par with face-to-face visits, and in some cases, wasn’t covered at all. Fast forward to March 2020: CMS announced it would reimburse telemedicine visits at the same rate as in-office visits—and many health insurers agreed they would do the same. 

In reality, “it’s just been a moving target, which has made billing right now very difficult to be able to process,” Dr. Morgan said. 

The technical aspect of telemedicine has also been a major challenge, he added. Some doctors “took to it like a duck to water” while others are still really struggling with it. Patients have had similar mixed reactions to it. Worse yet, some patients in rural areas just don’t have the bandwidth to support video, while others don’t even have internet service. 

Another drawback: practicing across state lines. Although the CMS has now allowed providers to perform telemedicine from any location to any location (ie, “emergency privileging”), many hurdles remained in place.

“What we've found out is that it’s fairly onerous in some cases to be able to go through the process that the states had set up for emergency privileging,” Dr. Morgan explained. “That was somewhat of a problem before [the COVID-19 crisis], but it became much more of a problem when you had many more people trying to practice across state lines.”

Another, more fundamental drawback: Virtual visits can’t fully replace face-to-face visits. “[T]here are some things that just don’t lend themselves to telemedicine,” Dr. Morgan said. A pregnant mom can’t get a sonogram over Skype, for example. Nor can a physician use a stethoscope to listen to the lungs of a patient with possible COVID-19–related pneumonia. 

Here to stay? 

But, the million-dollar question is: Will telemedicine remain on stage in a leading role, or will it retreat back into the wings once this crisis is over? 

“The broad consensus is that we will not go back to one-channel (in-office care) healthcare delivery,” ATA president-elect Joe Kvedar, MD, told MDLinx. He added that both doctors and patients appreciate having “more than one channel” for healthcare delivery. 

“The specifics of how many of the loosened reimbursement, technology, and licensure regulations will stick is unknown, but it is safe to say that there will be widely-practiced telehealth as part of our healthcare landscape,” Dr. Kvedar predicted. 

“I think the genie’s out of the bottle on this one," CMS administrator Seema Verma told The Wall Street Journal. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

Dr. Morgan foresees that telemedicine usage will have a slight setback after the COVID-19 crisis subsides and some people return to the doctor’s office. But, he added, it will continue to be a game-changer because payers now understand its value. 

“This is here to stay,” he affirmed. “And insurance companies are going to start to come along for a number of reasons. One, you're providing convenient care in a setting that the patient is much more comfortable with, and you’re reducing their risk to other diseases. Two, they're going to see that it’s good quality, which it is, and it's overall less costly to everybody because the technology is pretty cheap compared to a brick-and-mortar building.”

On the bright side

Dr. Morgan concluded: “I really think that the silver lining to this awful pandemic is going to be that we will learn how to take care of patients differently, in a convenient setting, and that when we see—which we will—either a resurgence of COVID or something else, we’re going to be much better prepared to be able to take care of patients in the future with these technologies.”