Thursday, November 26, 2020
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The future of Telehealth

The novel coronavirus pandemic has stretched health care systems to the brink. Covid-19, might be getting all the headlines, but patients are still getting sick from other diseases and injuries.

And that’s left doctors looking for other ways to treat them while minimizing contact.

Telemedicine is broadly defined as the use of electronic communications and software to monitor and treat patients in lieu of an inpatient visit.

Over the past decade, telehealth, a broader term used to define all medical services and health education delivered digitally, has grown steadily as an industry.

According to IBISWorld, the industry’s revenue has grown 34.7 percent from 2014 to 2019.

The market size in 2019 was around 45 billion dollars, but it’s projected to grow to more than 175 billion dollars by 2026.

Despite the increase in revenue, Americans have been slow to adopt the practice.

According to a 2017 study, 82 percent of U.S. consumers don’t use it. Like all of American life, that changed with the novel coronavirus.

The number of Medicare patients using telehealth has increased from roughly 11,000 a week to more than 650,000 people a week.

It’s led to a surge in usage for telemedicine companies such as Teladoc and American Well. And video conferencing company Zoom, whose stock is up more than 150% since the start of 2020.

Shares of Microsoft, which owns video conferencing software Skype and its teams platform, are up more than 14 percent since the start of 2020.

Telemedicine visits surged to 50 percent in March and are on pace to reach 200 million by the end of 2020.

That’s up from earlier predictions of 36 million America’s health care system has skipped the test run and jumped to using telemedicine as a primary means of care during the coronavirus pandemic.

Here’s how coronavirus could change the future of U.S. health care.

Telemedicine dates back to the mid 20th century when radios were used to provide medical advice on ships. In hospitals, the first usage was in the 1950s through a closed circuit television link for psychiatric consultations. In the last 30 years, telemedicine treatment has expanded to mental health, stroke and patients with chronic diseases like asthma, diabetes or heart failure. A number of research studies have found it to be an effective alternative and satisfying for both the patient and provider.

Telehealth proponents have sold it as a solution for patients in rural areas. Now they advocate it as a low cost and convenient option for tech savvy millennials and busy parents as well.

A 2019 American Well study found that 66% of Americans are willing to use telehealth, but only eight percent had already tried it.

Dr. Michael Barnett is an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health and a primary care physician at the Brigham and Women’s Hospital in Boston.

He’s published papers about telemedicine adoption in the U.S.

There are many different reasons why the use been so low. The first is that insurers are very worried that people would use too much telemedicine if they covered it too easily.

And so there are lots of restrictions on the kind of telemedicine visit that insurers will pay for.

So, for example, Medicare, which is the big federal government payer that covers older adults and the disabled, they only pay for telemedicine if somebody is a rural resident. And you also have to go to a specific kind of facility with a specific kind of equipment and has to be a doctor that you’ve already seen.

In addition to that, in the U.S., I think people are really quite attached to seeing their doctors in person. Their business model of doctors is very much tied to seeing patients in the office.

So they don’t have a lot of incentive to offer telemedicine because there isn’t really a whole lot of patient demand.

So when the government announced that they would lift telehealth restrictions for Medicare, it was a big deal.

Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly used services like FaceTime and Skype. The move paved the way for private insurers and others to waive their restrictions. However, the new exceptions didn’t void requirements states might have for telehealth.

Telemedicine has been cast as a tool to protect medical professionals from exposure to Covid-19, to help reduce reliance on personal protective equipment and keep the vulnerable and healthy at home.

Now, coronavirus could boost telehealth interactions to one billion by the end of 2020. Telemedicine companies like Teladoc and American Well have seen a big boost in users during the coronavirus pandemic.

They’ve been able to meet demand thanks to most states temporarily modifying their license requirements for doctors, meaning a doctor in one state can diagnose a patient in another state.

That’s led Credit Suisse listing Teladoc as one of their top 10 investment ideas amid Covid-19.

Berenberg Capital Markets predicts the company’s market opportunity can only head upwards.

And William Blair has called it the only clear beneficiary of the Covid-19 outbreak in our universe.

Even tech companies are entering the telemedicine space.

Microsoft, for instance, has been developing chatbots, has collaboration software like Teams. They also have video conferencing services. Same with Apple and Google.

While telemedicine on paper looks like a near perfect solution for policymakers. It isn’t always the best solution for providers or patients.

According to Dr. Jessica Bender who is a primary care doctor and a clinical instructor of medicine at the University of Washington, Telehealth is not for all issues. We want to provide the right care to the right patient at the right time. Some medical issues just cannot be resolved over the phone or over video and require an in-person visit.

Doctors are not always paid the same amount for a virtual visit as they are for an inpatient visit.

Additionally, to access telemedicine services, patients need reliable Internet access.

Telehealth has a risk of exacerbating pre-existing inequities in health care, in either access to care or in health outcomes.

But  the digital divide is still real. Large parts of the world are rural and may not have access to high speed internet, for instance.

While most health systems have been able to quickly adapt, there are still ways to improve. We’re seeing hospitals start to strike these deals with telemedicine companies.