When the coronavirus hit, medical practitioners started ramping up their virtual offerings – notably appointments via videoconferencing apps such as FaceTime and Zoom – as a way to continue caring for patients and keep their businesses alive. At the same time, regulators loosened the rules that had restricted telemedicine. In the U.S., for example, officials eased enforcement of the Health Insurance Portability and Accountability Act, which sets strict privacy standards. Also, government insurance programs Medicare and Medicaid expanded the types of services covered and began paying for virtual visits at the higher, in-person rate. A report from McKinsey & Co. in June concluded that 46% of consumers in the U.S. were using telemedicine, up from 11% a year earlier. Industry analysts expect the trend toward acceptance to continue. Coronavirus will likely remain a health threat for the next several years, until immunity gained from vaccines and infections is widespread globally. By then, telemedicine is likely to be an embedded part of the health-care ecosystem. McKinsey estimated that with changes such as replacing 20% of emergency room visits and 25% of health-care office visits, telemedicine eventually could account for a fifth of all Medicare, Medicaid and commercial insurance spending on outpatient, office and home health care. That would amount to $250 billion in 2020, compared with the $3 billion the industry generated annually in the U.S. before coronavirus hit.
For most of its history, telemedicine was used mainly by people in hard-to-reach areas – in the most extreme case, astronauts on the International Space Station. It was seen as a small, bonus product for health-care providers who primarily cared for patients in person. In the U.S., Medicare, which covers the elderly and often sets industry standards, was one of the main stumbling blocks: It only paid for telemedicine if patients were in rural areas and went to a local medical facility that connected them remotely to experts. Restrictions on health professionals working across state lines – since suspended for telemedicine – further constrained its use. For years, demand for the technology rose slowly, with the most enthusiastic users younger people accustomed to connecting with people and getting goods and services over the internet. The largest providers focused on virtual urgent care, helping patients get immediate visits, often with doctors they didn’t know. Growth was held back by concerns among patients, health-care organizations and doctors that telemedicine would lead to lower-quality care, poor results and inconsistencies in diagnoses and treatment plans.
Now that patients and physicians are on board, they’ve found unexpected benefits. For patients, telemedicine can make it faster, cheaper and safer to get medical care. They don’t have to take as much time off regular activities, travel to the doctor’s office, possibly pay for parking, or wait for the start of an appointment, perhaps in a room crowded with sick people. For physicians, the practice, once established, often saves time, allowing them to care for more patients and potentially increase profits. A growing body of evidence shows that telemedicine is just as good as in-person visits for many types of medical care, and even better for others. A study from the University of Texas Southwestern found it led to an increase in patients getting specialized care and fewer missed appointments in April 2020 compared to the same month a year earlier. A 2018 study in rural and remote regions of Australia found that a telemedicine program connecting local clinics to cardiology specialists at a metropolitan location boosted testing for heart disease by 42% in a single year; it reduced driving time by more than 300 miles (500 km) per patient and shaved about two weeks off the time required to get a test and more than a month off the wait to receive results. Still, limitations remain. Nothing replaces the nuances doctors can pick up using all their senses in an actual visit. Even the basics, such as listening to the heart or getting a blood pressure reading, can’t be done remotely in most cases. Lots of patients, including many who could benefit the most, have difficulty accessing telemedicine. One in three Americans over the age of 65 has trouble connecting with a doctor remotely, often for lack of the necessary equipment or technical skills, according to a study from the University of California in San Francisco. Patients with disabilities, especially those who have hearing, visual or cognitive issues, are particularly limited.
The Reference Shelf
• Related QuickTakes on the coronavirus and its unanswered questions, the race for a vaccine and better treatments, and the virus and kids.
• McKinsey & Company reports on the future of telemedicine.
• A study in Australia showed benefits to telemedicine.
• The U.S. Centers for Medicare & Medicaid Services details expanded telemedicine benefits.
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