Telemedicine existed in the pre-pandemic world — spending the past several years trying to gain a foothold among Americans while mostly stymied by a range of regulatory restrictions designed to protect consumers against fraudsters and those who would inflate costs.
But then the pandemic hit with the force of a meteor, pushing regulators to amend or suspend guidelines that critics say held back telemedicine’s advance in America. As a result, the industry has come out of its niche and moved squarely into the mainstream in just a few short months.
Telehealth got its first big boost in March when the President Donald Trump administration temporarily eased Medicare rules for telemedicine visits. Healthcare providers can now receive Medicare and Medicaid reimbursement for telehealth visits at the same rate as those provided in person.
That pushed many private insurers to adopt similar temporary rule changes and provide compensation parity for telehealth providers. That, in turn, persuaded more doctors to offer digital health services and market them more actively to patients.
Such an expanded educational effort is particularly crucial in pushing telehealth forward, since there have been issues around consumer awareness that telemedicine is even an option.
“The awareness piece is a big problem,” Dr. Ian Tong of Doctor On Demand told CNBC in 2018.
Doctor On Demand is an app that offers smartphone consultations with a physician at affordable prices.
“Consumers are realizing that it can all be done via an app, whether it’s getting a prescription, an exam or ordering labs,” Tong told CNBC. “There’s no need to sit in that waiting room anymore.”
And starting in March, there was no ability to sit in a waiting room anymore anyway, as doctors closed their doors to protect themselves and their patients from potential COVID-19 exposure. Suddenly, awareness of telehealth as an option was no longer an issue and demand spiked, according to recent reports.
For instance, Fortune reported that telehealth sessions rose from about 4 percent of New York Presbyterian Hospital’s outpatient visits before the pandemic.
"During the crisis, it's 85 percent,” said Dr. Steven Corwin, the hospital’s CEO. “And 95 percent of our outpatient psychiatry visits are now telemedicine. Physicians have now basically crossed the Rubicon."
Corwin noted that doctors can even remotely monitor patients who’ve been diagnosed with COVID-19 but are not sick enough to merit hospitalization. Reports also indicate that since the pandemic began, telehealth visits by Medicare seniors have soared from a few thousand per week to just over 1.3 million.
Virtual therapy sessions have also more than doubled. Moreover, telehealth boosters point out that low-income patients are less likely to miss telehealth appointments as the sessions are easier to attend.
The question now as stay-at-home orders come to an end is whether telehealth’s huge expansion will hold. Corwin told Fortune he thinks so — particularly in a world without a COVID-19 vaccine.
"You can’t have 30 people in a waiting room or 15 people in an elevator anymore,” he said. “This has all changed dramatically, and there’s no going back on that."
It increasingly seems that legislators are coming around to Corwin’s way of thinking, pushing to make the temporary regulatory changes that have boosted telemedicine permanent. The issue will head to Capitol Hill this week as the Senate’s Health, Education, Labor & Pensions Committee hosts a hearing on telehealth’s pandemic-related boom.
“Telehealth has rapidly transformed from a technocratic, wonky issue to an essential strategy for keeping people alive,” Sen. Brian Schatz of Hawaii told Politico ahead of the hearing. “We’re going to realize that all the changes we enacted ought to be permanent.”
That isn’t to say that there aren’t telehealth skeptics. Some worry that medicine offered remotely opens the door to crooks, while others think the system will run up U.S. healthcare costs even higher through patient overuse.
But Medicare chief Seema Verma said recently that she thinks telehealth will remain, although likely with some tightened federal regulations.
“I just can’t imagine going back, because people recognize the value of this,” Verma said, according to STAT.
Politico said lobbying efforts in favor of such changes are currently underway, with groups like the American Hospital Association and the American Medical Association asking the U.S. Department of Health and Human Services (HHS) to make telehealth expansion permanent.
However, some changes require congressional approval. The House is currently considering a bill that would direct HHS to study recent telehealth use to see how to safely reimpose any necessary pre-pandemic restrictions without cutting off care to patients. Other proposed legislation would simplify HHS’s process for waiving stricter telehealth rules in future emergencies like disease outbreaks or natural disasters.
But telehealth advocates are becoming impatient with delays. They believe the pandemic and the veritable explosion of consumer and physician interest in telemedicine that it created are all the evidence necessary for what has to come next.
The "history of telehealth regulation has been that, at every opportunity … federal and state policy makers will use such a proposed study as a reason to delay making any decision. It is time for action, not more studies,” Jon Linkous, who headed the American Telemedicine Association for 24 years, told Politico.
It remains to been seen whether HHS and Congress and agree.