Over the past year, the rise in telehealth services — as well as the continued spread of COVID-19 variants — has left many patients and PCPs wondering as to whether or not these services will continue expanding in the months, or even years, to come.
The onset and subsequent spread of the COVID-19 pandemic has left virtually no global industry or market untouched. The health care industry, especially in the U.S., is no exception to this. While businesses and their leaders were forced to pivot internal operations and processes essentially overnight to adapt to the spread of the COVID-19 virus, health care professionals and providers in the U.S. were quick to follow suit in their adoption and expansion of virtual health care, telehealth, and remote patient monitoring services, in order to better protect the health of primary care physicians and their patients alike.
Nevertheless, over the past year, the rise in telehealth services — as well as the continued spread of COVID-19 variants — has left many patients and PCPs wondering as to whether or not these services will continue expanding in the months, or even years, to come. When we take into consideration not only the rise in telehealth services offered prior to the pandemic, but also the unprecedented utilization and integration of these services throughout the pandemic, the data tells us that both PCPs and patients are expecting those services to continue growing.
According to Meg Barron, vice president of digital innovation at the American Medical Association (AMA), the percentage of PCPs offering telehealth services doubled from 14% to 28% between 2016 and 2019 — well before the COVID-19 pandemic officially began. Since that time, however, Barron estimates that some 60-90% of PCPs have begun integrating a broader array of telehealth services into their health care practice. Of those PCPs, Barron states that approximately half are utilizing telehealth services for the first time.
Indeed, a larger portion of PCPs than ever before have witnessed firsthand the benefits that expanding their digital services and tools can have insofar as aiding the safety of their patients and efficiency of their practices’ internal systems and processes. Although, with that said, many PCPs and other health care professionals still have many questions left unanswered regarding how the continued integration and growth of telehealth services can impact their needs.
For instance, many PCPs are wondering as to whether or not changes instituted during the pandemic to expand telehealth services (e.g., the eligibility of Medicare patients and newly registered patients) will remain. If they do, this further begs the question of how those changes might affect their practices, such as the waiving of licensure requirements for licensed PCPs providing specific COVID-19 countermeasures or temporary licenses allowing them to provide telehealth services (including prescribing medications containing controlled substances) to patients in other states. Similarly, how might these changes impact a PCP’s ability to receive proper payment, or be held liable for patients in other areas of the country?
In order to answer these questions, we must look to ways in which telehealth services can best be optimized for both PCPs and patients moving forward.
As one report from McKinsey states in reference to the growth of telehealth services provided throughout the COVID-19 pandemic, between 40-60% of healthcare consumers in the U.S., “...express interest in a set of broader virtual health solutions, such as a ‘digital front door’ or lower-cost virtual-first health plans.”
That same report likewise shows us that the majority of PCPs view telehealth as a digital service more favorably than they did since the initial onset of the COVID-19 pandemic. Nevertheless, approximately 54% of PCPs surveyed for the report stated that they would not be willing to offer a 15% discount to their patients who are willing to prioritize telehealth visits over physical in-person care. Considering this, creating a stable and scalable foundation for an equitable reimbursement model to provide cost savings potential for both PCPs and their patients could allow health care providers, as well as their care recipients, with greater affordable access to virtual health care and telehealth services.
One way this can be accomplished is through a broader integration by PCPs of machine learning and artificial intelligence (ML/AI) elements into their medical coding procedures and billing systems. Similarly, the ML/AI tools used to conduct both telehealth and remote patient monitoring services (especially for higher-risk patients), must become easier to integrate into existing systems used by PCPs in their practice. Doing so will not only allow for telehealth services to remain more broadly affordable and accessible for PCPs and their patients with the potential for stronger and more stable reimbursement procedures, but will also assist PCPs in optimizing the clinical workflow of their practices while simultaneously minimizing — if not, significantly mitigating — human error and risks, both known and unknown.
Along with the additional ways telehealth services can best be further utilized and integrated into health care post-pandemic, a wide number of PCPs and MDs have cited changes already made as a result of the pandemic that they believe should remain after the pandemic is officially declared “over.” According to Steve North, MD, MPH, reporting for the American Academy of Family Physicians (AAFP), the regulatory changes made related to telehealth services resulting from the pandemic can be classified into four primary categories:
1. HIPAA flexibility
2. Medicare and Medicaid policy changes
3. Licensure requirements, as mentioned briefly above, and;
4. Prescribing of controlled substances, also mentioned briefly above.
Though the changes to each category referenced will undoubtedly require additional regulatory changes moving forward if they are to remain, the foundation for expanding upon these changes has already been laid out for PCPs and their patients. For example, in the case of HIPAA flexibility, expanding upon “non-public facing” video conferencing platforms in regards to telehealth services must evolve to address issues such as patient confidentiality, data security, as well as technological literacy for less tech-savvy patients. This could potentially be accomplished through insurance and health care providers aligning to provide more secure and user-friendly ML/AI systems in their telehealth services.
Additionally, as North states, policy changes to Medicare and Medicaid at both the federal and state levels resulting from the pandemic, such as, “...allowing [PCPs] to be compensated for the telehealth services they provide,” should remain in place after the pandemic’s official conclusion. This is largely due to many patients eligible for Medicare and Medicaid living in traditionally rural areas and descending from traditionally underserved or marginalized population demographics.
By eliminating pre-existing barriers to accessible telehealth services, including originating site requirements for Medicare and Medicaid, commercial insurance reimbursement, and the ability to treat and prescribe medication for patients across state lines, we can increase affordable access to virtual health care services and establish a stronger foundation for true health equity.
Overall, the changes made to virtual health care and telehealth services throughout the past 12-18 months have left a seemingly permanent impact on the healthcare industry. The demand for the continued expansion and deeper integration of telehealth services by both PCPs and patients across the U.S. is more apparent than ever before. With that said, PCPs likewise must make their opinions on these matters known to their patients, congressional representatives, as well as the general public. Through increasing the ways PCPs and their practices can continue investing in additional and improved telehealth services, we can collectively ensure that telehealth remains affordable, accessible, and more equitable for each PCP, provider, and consumer of health care services in the US.