Before the coronavirus outbreak leading to devastating COVID-19 infections, telemedicine struggled to become more than a niche industry. Hampered by government restrictions and reimbursement issues, telemedicine was never fully embraced by most doctors, patients, or mainstream healthcare institutions. It’s still unknown whether the flurry of activity due to the current crisis will lead to a more lasting shift toward greater use of telemedicine.
Despite the barriers to its more widespread adoption, telemedicine is considered by some individuals and institutions as a promising growth industry. According to a survey by Amwell, only 5% of doctors had used telemedicine to some degree in 2015. By 2018 this number had increased to 22%. Despite this apparent interest, a 2018 survey by Deloitte revealed that relatively few doctors have video visit capabilities. This is likely to increase as a result of the demand for virtual visits due to the coronavirus crisis.
One of the frequently cited features of telemedicine is that Americans living in rural and more remote locations will have better access to health care services. With few physicians compared to metro areas, these are the patients, usually older and sicker, who are in a position to benefit the most from telemedicine access.
Unfortunately, more than a quarter of rural residents — 12.4 million people — lack the minimum broadband speeds needed by most telemedicine services, according to the Rural Health Information Hub, Lack of widespread access to high-speed internet is an often overlooked barrier to telemedicine’s growth potential.
Paradoxically, doctors find themselves spending more time per patient when seeing them via telemedicine instead of in-person (medpagetoday.com). New York neurologist Todd Maltese says It takes his patients an average of 10 minutes just to get their software operational. He adds that several times he has spent a half-hour serving as his client’s IT consultant before starting an appointment.
“Most patients are not 20 and tech-savvy; most are older and need to be walked through it, and I don’t have the staff to do it,” says Dr. Maltese. This time-consuming burden causes delays in seeing previously scheduled patients.
“Telemedicine won’t replace exams and procedures,” says Boston urologist Peter Steinberg in a recent Wall Street Journal article, “and not all of medicine can be conducted over an app, much like you wouldn’t want every interaction with your friends and family to happen over FaceTime.”
He agrees that telemedicine has its place, primarily “for discussing lab or imaging results and handling minor complaints that don’t require an exam.” He adds that “the main barrier to telemedicine has been how doctors are paid and complying with cumbersome reimbursement requirements.”
Due to the coronavirus crisis, insurers and the Centers for Medicare and Medicaid Services have temporarily eased restrictions to paying doctors for telemedicine visits. It remains to be seen whether these changes are here to stay.