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Todd Shryock, contributing author
The pandemic brought telehealth into the mainstream, but will government and private payers make the right moves to make it a standard part of medicine?
The pandemic took what was mostly niche telehealth technology and brought it to a much larger patient population. Without it, many primary care practices wouldn’t have been able to see enough patients to stay open. But as the novelty has worn off and people have regained confidence in going to in-person appointments, both the government and private payers have begun making moves that will impact the technology’s long-term viability.
Medical Economics spoke with Thomas Conroy, CEO, MedSign, about how telehealth is viewed and what its future might look like.
(Editor’s note: The transcript has been edited for brevity and clarity.)
Medical Economics: With the massive expansion of telehealth during the pandemic, how well has it worked out for both doctors and patients?
Conroy: When we talk about telehealth, thank goodness that the government sort of got it right by expanding the use of telehealth across the board here. As you know, in the beginning, telehealth was positioned for rural areas and now it's across the nation. I think it's a learning process. Because of COVID and the inability to get the physician's office, telehealth has opened up the door, but we have got to do a lot more than that. We need to make some technology changes to enable those who are, let's say technology averse, to access telehealth, in the comfort of their home, and I'm talking about seniors. So I think overall, for doctors, you'll find that the younger doctors are totally open minded and want to embrace telehealth and maybe the older doctors are the type that would like to see the patient in the home. And they're going to learn over time that this is an incredible tool that they'll have in their war chest to help to keep people healthy and well in the home.
Medical Economics: Getting telehealth to this point required a lot of changes from the government. The Trump administration announced several changes to telehealth recently; what did they get right and what did they get wrong about it?
Conroy: I think they really got it right. Early on, they decided to allow telehealth especially because of the fact that the COVID-mandated isolation and confinement forced millions of Americans in the home. I think just allowing telehealth to expand across the country was an incredible mark for the administration. They also got it right by paying providers the same reimbursement rates as if they were giving care in the office. And that was critical at the time. I think that over time, we're going to see a change and telehealth is here to stay, and it's going to change the way healthcare is provided in the future. But more so, I think it's going to reduce costs in a hospital.
Medical Economics: In the past, Medicare primarily focused telehealth benefits on rural areas where care could often be hard to access. Is that the right approach?
Conroy: CMS took what they were doing in the rural areas and applied it to a nationwide program. Absolutely, it was a great way to start, and they understood some of the shortfalls there. What we need to do though, and being a technologist, we need to make sure that the information that's provided and the connectivity that is provided is for all Americans, and not just the young people today. They all understand just having happiness in your hand in the form of a cell phone is the way to go, because that's what they live by. We're going to see more and more of that as we progress in the telehealth arena. But we have to embrace those people and get others to adopt the system, and I think CMS has done that in the beginning here very well.
Medical Economics: Many patients that used telehealth have since returned to in-office visits, and doctors that reported a lot of telehealth usage in early 2020 now say it's declined. What does that say about the long-term future for telehealth in medicine?
Conroy: I think this is a generation issue. The old generation wants to be able to go into the doctor's office, look them in the whites of their eyes, and get the people to care for them personally. The young people, they're used to the use of technology that exists today, and it's just only going to grow. We're not really seeing a real reduction, but an increase in in-home and in-office care. But what we are seeing is that the seniors would like to actually talk and see the doctors themselves. Well, that will change over time as telehealth becomes commonplace. And what you really have to consider is, there's another area of seniors that is really important: those who have chronic diseases. They don't want to go to the hospitals, they don't want to see their doctors, they want to sit and stay in the comfort of their home, but you have to provide technology that enables them to do that. And there's technology out there, like the one that I'm working on, that enables the seniors to talk to the physician or their nurse, or even their loved one, through the comfort of their home using a home television set. And I think that if we can apply that common technology that is in 120 million homes, we get to sell a winner here. When we talk about the seniors, you have to provide them what they know best, and that’s access to a product that they use every day in their home, and it's a television set. So that will be the embracement part. The adoption part that telehealth needs is you have to bring in those people that are pretty much using most of the Medicare and Medicaid dollars. It's the seniors over 75 years of age especially. And here's the other thing, that population is growing. Think about it: Because of all the health care that they're receiving, they are living longer. We have to make sure that we can embrace those folks, and the way you do it is providing technology so that they can adopt it with ease.
Medical Economics: How have private insurers approached telehealth and have they gotten it right?
Conroy: Yes, and no. There's still a weeding-out factor, and the government and the private insurers really have to get together on this. Let's face it, COVID forced us into this new arena called telehealth across the country. Before, telehealth was rural. I think on the private insurers’ side, there's a real lack of understanding on the potential of telehealth right now. They understand it, but I think over time they will start seeing the analytics or statistics showing that it's better to have telehealth to reduce the cost of a hospital stay than it is not to have it. Now, I will say that one of the things that's a problem right now that companies have to explore and they have to include is you have to build controls into the telehealth sessions. And, if you may recall, early in 2020, there was a telehealth fraud in Florida to the order of $1.2 billion. They were having cases made up and they were caught. There are roughly 300 people involved in this, because there were no control mechanisms built in. It’s the wild west of telehealth right now, and it is “get a session-get paid.” But if you can build controls that enables even Medicare to look in, even with using HIPAA as a baseline, look in and make sure that it's a true telehealth session, you'll see that the economics will be a lot better with telehealth built into the system. It’s still a learning process for these folks, but it will change over time. It's going to be a common item just like going into your doctor's office, getting your blood pressure, getting your weight and temperature—this will be commonplace.
Medical Economics: Some experts have indicated that if you make telehealth too easy to use, it will lead to an explosion in unnecessary costs because people will use the service just because of the convenience factor. Is this a valid argument?
Conroy: It is, but again, it's sort of a learning process for everybody. I think the young adults are going to use this when they need it. What you have to build in, as I said before, you have to build in controls in this whole process. And that's where I would focus my attention on, and we have focused our attention on, how do you control the system so that you have true telehealth sessions that are approved?
Medical Economics: Are there still technological challenges with telehealth, and if so, how can they be fixed?
Conroy: Yes, the technological challenges are the fact that you're not reaching 35 million people who are senior citizens. And every day, it grows by 10,000—every day for the next 15 years. Some of those people are ready. They understand the iPhone, smartphones, tablets, but 35 million people out there do not. And so they're technologically a challenge. There are 260 telehealth companies out there, and they're all vying for the same space and use smartphones and tablets. Seniors don't use those things. So, you have to develop a develop a technology that seniors will adopt. So that's the challenge. How do you get into that senior home? How do you get them to adopt it? But the second challenge is how can you go and perform an examination in a home? And that would be to me is very critical and in providing a better health and wellness system for a person, especially the elderly, many of whom are disabled. You have to take that technology aversion away, and you have to gain adoption.
Medical Economics: What will ultimately drive greater telehealth adoption: reimbursement that's on par with in-office visits or just patient demand for it?
Conroy: Both. Appropriate reimbursement is critical. The doctors have to get reimbursed for this, but you have to have people wanting to do this. Seniors want to stay at home. They don't want to go out on the road. I don't want my dad who is a 92-year-old World War II vet, he's got to go down to the VA to see a physician. I don't want him getting in a car traveling. They're sitting there for an hour potentially getting COVID while he's there, and then driving back and not getting in an accident. So, I think the drive here is including systems that's easy for them to use. But on the medical side, full reimbursement for a telehealth session is important. And may I also point out something that's really important I didn't mention earlier: medical equipment is reimbursed but telehealth-specific equipment is not being reimbursed at this time. I understand why the government is hesitant on reimbursing telehealth equipment, because anybody can say a computer or a laptop is reimbursable, and that's not going to happen. So, if you design telehealth specific equipment, the government should allow that to be a reimbursable event.
Medical Economics: 10 years from now, what do you think telehealth will look like? And how widespread do you think it will be?
Conroy: It's going to be universal. I think we're going to get it right. There's lots of companies working on it. I think we're going to see that it's going to go have a global impact too. I can see telehealth being provided to other countries through the United States. With the technologies that are coming down the pipe, you're into some pretty exciting things and of course on top of it, besides having telehealth, you should have a fully automated home that's fully embraces somebody that's disabled, and you should have the ability to send medical information anytime, anywhere that they need it. And I'm talking about physicians who need it. Then finally there is AI. There are not enough nurses out there, there are not enough doctors. So, what are you going to do? You should have AI be a part of your system that enables the doctors to get a full pre-evaluation before they talk to the patient. I think AI is going to be absolutely critical in anybody's roadmap o