Telehealth works, don’t mess it up

Regulators and payers should work to make sure it remains available

COVID-19 HAS ALTERED all of our lives in devastating ways, and has fundamentally changed healthcare in the United States. One silver lining is a change that has dramatically improved healthcare for millions of patients: telehealth. However, these convenient, essential, and sometimes life-saving visits we have all come to rely on are under threat if legislators and payers do not recognize telehealth’s essential part in keeping all Americans healthy.

Since the start of the pandemic, countless millions of patients have come to rely on telehealth. Often, it is the only option for health care for the most vulnerable patients, and it has brought previously unavailable care to patients in rural and underserved areas, those who cannot get to a doctor’s office, and those whose only alternative is an ER visit after they are much sicker.

If the question is around the financial impact, which at this juncture in legislative decision making, it is, these intensive patients are the ones who will cost the system the most if they are not treated with telehealth. And while we most often think of telehealth as using video, the telephone is a critical component as well.

Take David, who is in his mid-70s, and his mother Lucy, who is 98.  Neither have a smart phone, and neither are technologically sophisticated. Lucy is morbidly obese, a diabetic, and has a history of chronic heart and lung disease. It has become almost impossible for Lucy to leave the house without David getting help from neighbors, or having one of his children travel several hours.

We have cared for Lucy and David for 35 years and recently telemedicine, even without the visual component, has opened up new ways to keep Lucy at home, comfortable, and safe. Telehealth has allowed us to have discussions about palliative care, hospitalization or home care, and eventually hospice.  Multiple (expensive) ambulance rides to the ER have been avoided, which would likely have led to unwanted (and expensive) hospital stays.

Physicians have always used the telephone as a means of communication and a means of delivering health care, without compensation. Whether in a fee for service payment model or in a capitated model, there has always been the “pressure” to see patients in the office to allow for reimbursement. Taking that rationale away allows the provider and the patient to decide what is best for the patient at that time.

It is our most vulnerable patients who have limited access to transportation and limited abilities to use modalities like Zoom or Doximity. It is our most vulnerable patients who need support from family or friends at the time of the visit, which is more limiting when we have to see the patient in person given the time commitment.  Affording patients the opportunity to decide their treatment location with their provider will improve access, improve compliance, and decrease the use of the ER or urgent care sites.

Meet the Author

Barbara Spivak

President and CEO, Mount Auburn Cambridge Independent Practice Association
In our conversations with other physician leaders across the country, telehealth is being used in somewhere between 10 to 15 percent of their visits. This certainly does not seem excessive or wasteful.

Barbara Spivak is president and CEO of the Mount Auburn Cambridge Independent Practice Association.