Last spring, doctors’ offices across the country were eerily quiet. Almost overnight, patients stopped coming in as COVID-19, and the fear that the novel coronavirus begat, spread through communities across the country.
Healthcare providers quickly adapted. “We were able to pivot to using telemedicine as another mode in terms of connecting with patients,” recalls physician Thomas Caprio, a professor of medicine and geriatrics at the University of Rochester Medical Center in New York.
In-person visits didn’t stop altogether, of course, but they dropped precipitously while telehealth visits rose. In the first quarter of 2020, telehealth appointments increased by 50%, according to the Centers for Disease Control and Prevention. In the last week of March alone, they were up 154% compared to the same period a year earlier.
As the weather warmed and cases declined, the telehealth spike deflated somewhat; the number of virtual appointments declined while in-person visits ticked upward. But with the arrival of colder weather and a second COVID wave, telehealth surged anew.
Despite the unprecedented number of confirmed cases in the U.S., more people are opting for in-person visits compared to the spring, when less was known about transmission. With widespread vaccination distribution in sight, the question becomes: What’s the long-term state of the telehealth union? Is it where its boosters or skeptics believe it to be, or somewhere in between?
“Our prediction is that the market has fundamentally changed,” says Peter Alperin, an internal medicine doctor in San Francisco and VP of product at Doximity, a social network for physicians.
According to Doximity, before COVID-19 less than 10% of doctor appointments were virtual. In its 2020 State of Telemedicine Report, the company predicted that telehealth appointments will account for 20% of all medical visits in 2020, representing $29.3 billion of medical services. Doximity projects that figure to increase to a whopping $106 billion by 2023.
Caprio’s personal experience broadly aligns with this. While telehealth usage remains elevated compared to pre-pandemic levels, during the summer and into the fall most of his patients wanted to see him in-person. His wife, a nurse practitioner, has noticed a similar trend among her patients. Overall, telehealth has proved itself to be, if not a game changer, then “another tool in our toolkit,” Caprio says.
Much hinges on long-term telehealth adoption, which remains an open question. For providers and patients, it’s often a matter of personal preference.
When it comes to his patients, Caprio has yet to find a formula for determining who is or isn’t open to virtual visits. Ostensibly revealing indicators such as digital literacy and medical history don’t seem to have much of a determinative effect. Many patients who are tech-savvy and have a straightforward question prefer in-person visits; others who are less comfortable with computers and have complicated medical histories have few reservations about making the transition to telehealth.
Before COVID, Caprio was “ambivalent” about telemedicine. Now, he sees its distinctive advantages and believes that, for many medical needs, the visits can be just as informative as in-person ones.
“There is a lot I can do by observing patients on camera,” he says, pointing to depression screenings and cognitive tests. He adds that new patient visits rarely pose a problem, particularly when the patient provides a detailed medical history.
What’s more, Caprio has seen firsthand telehealth’s ability to increase access. Patients who were unable to make early morning appointments because of the commute or who might have canceled during poor weather conditions can now log in from home.
“We can meet with a patient and family and come up with recommendations and care plans,” Caprio continues. “I don’t want to do 100% telemedicine practice, but I can see this being a significant portion of what I do in the future.”
Of course, it’s important to note that telehealth doesn’t eliminate issues around access. A significant percentage of Americans, particularly those in vulnerable demographics and in rural communities, lack adequate broadband connection to support video visits.
And then there’s the question of coverage. In the spring, payers agreed to cover the full cost of a range of additional telehealth services. According to David Lindeman, director of health IT firm CITRIS Health, many of these provisions were enacted as waivers. As a result, it’s unclear whether they will evaporate once vaccines become readily available.
“It depends on whether the Centers for Medicare & Medicaid Services, the state governments and providers work together to make many of the changes permanent,” Lindeman notes. While a number of private payers “have moved in that direction,” Alperin adds, “Medicare is the 800-pound gorilla.”
Mental healthcare has proven a natural fit for a from-afar approach. On the other end of the spectrum are specialties such as oncology, which never saw a significant drop in in-person visits even during the spring of 2020. As for general practice, well, it falls somewhere in the middle.
Even a telemedicine booster, such as Caprio, can’t entirely hide his reservations. “I do have a sense of a loss of not being in the same room as the patient,” he says. “I can connect with them and I can see them, but it doesn’t quite feel the same as being in the same room.”
Trained in the art of physical examination, Caprio typically uses all his senses when examining a patient. “I’m not doing that to the same extent with telemedicine,” he continues. “There are trade-offs.”
Still, for Caprio, telehealth’s benefits — as a complement to, if not an outright replacement for in-person care — outweigh the costs. Going forward, he expects many providers and patients will opt for a hybrid approach.
Lindeman agrees. “I do think telehealth is here to stay. We have shown how effective it can be.”
This article first appeared on mmm-online.com.