JOHN HOOD COLUMN: Telehealth genie has escaped its bottle
Published 9:35 am Wednesday, May 11, 2022
RALEIGH — Before the onset of COVID-19 in early 2020, patients who preferred to obtain medical services through video chats or phone calls were unlikely to be reimbursed for those expenses. Medicare, for example, covered telehealth visits only for patients in remote rural areas and only if they journeyed to some other institution — a doctor’s office, say, or a clinic — in order to consult with a provider based elsewhere. Other third-party payers followed similar protocols.
The pandemic loosened these constraints, for a time. Private insurers expanded coverage to include many more telehealth services. The federal government adopted temporary rules to allow its programs more latitude, as well. In March, Congress enacted a budget bill that, among other things, extended Medicare’s broader coverage of telehealth for a few more months.
Why not make the status quo permanent? I think we ought to, although I grant that the issue isn’t a simple one. There are plausible objections that deserve careful consideration.
For example, some policymakers believe reimbursing patients to “see” providers from home rather than going to medical clinics or physician offices will result in worse health outcomes. Some services can only be delivered effectively in person, they argue, which is clearly true. In addition, while being examined, patients who come in for one condition or procedure may exhibit signs of something else that requires immediate attention — something that may not be detected in a video chat or telephone call.
And as far as the already exorbitant cost of medical care is concerned, some policymakers worry that expanded access to telemedicine will make it easier for patients to consume services of little incremental value, thus increasing revenue to providers without any noticeable gain in outcomes.
Notice that these objections are practical ones, not philosophical ones. Pretty much everyone grants that telehealth has the potential to lower costs and improve the patient experience. For many routine visits, check-ups, and monitoring sessions, that potential to deliver the service without travel times, waiting times, and excessive overhead ought to be of great interest to all concerned.
So, does the practice of telehealth deliver on that potential? Real-world experience during the pandemic looks promising to me. In a new research paper jointly published by the Progressive Policy Institute and Americans for Prosperity, researchers found big cost savings. Before COVID, only 134,000 Medicare patients were receiving weekly care via telehealth. After the reimbursement policy was temporarily broadened, that number shot up to an astounding 10.1 million.
“Between January 2020 and February 2021, the average telehealth patients’ health care expenses fell 61 percent, from $1,099 per month to $425 per month,” the authors found. “Furthermore, telehealth patients purchased fewer in-person health care services such as emergency care during this time period. This suggests virtual care improves patient health and allows individuals to purchase fewer expensive procedures.”
Other research predicts similar benefits. A March 2022 paper in the journal Pain Management Nursing found that offering telehealth to veterans resulted in a gigantic 83 percent reduction in missed doctor visits, which likely had salutary effects on both cost and health outcomes. “The findings from this project demonstrate that telehealth can be used as an alternative to in-person care for people in pain,” the authors wrote. “Telehealth is also a long-term sustainable option for patients with higher probability of missed appointments or people who may have transportation challenges.”
Other studies show positive results for diabetes monitoring, post-surgical rehabilitation, anxiety disorders, and the evaluation and treatment of musculoskeletal disorders. In the diabetes case, the research team concluded that “digital health interventions” appear to “improve glycemic control and reduce the need for caesarean delivery.” Both outcomes represent major improvements not only in the health of diabetics and their families but also in controlling the costs associated with the disease.
In surveys, most patients receiving virtual care report high levels of satisfaction. Let’s face it: the telehealth genie will never be crammed back into its pre-COVID bottle. Time to give it more explicit — and lasting — instructions.
John Hood is a John Locke Foundation board member.