Q&A: Will Congress act to extend, expand telehealth coverage beyond COVID-19?
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With the onset of COVID-19, health care providers implemented telemedicine to safely expand care to patients and comply with public health guidelines.
The Centers for Medicare and Medicaid Services recently acted in the best interests of patients and health care providers by covering telehealth services through 2023. But what will happen to telehealth coverage after 2023?
“The patients who are actually getting the care love [telemedicine],” Naresh T. Gunaratnam, MD, AGAF, told Healio. “The people providing the care love it. So, we really want Congress to expand coverage of telehealth services so that we don’t lose the flexibility telehealth gives us to meet the needs of our patients.
Healio spoke with Gunaratnam a practicing gastroenterologist at Huron Gastro in Ypsilanti, Michigan, and chair of data analytics at the Digestive Health Physicians Association, about a recent survey that examined patient and physician perception of telemedicine and highlighted the importance of maintaining a hybrid model of care that includes in-person and telemedicine visits.
Healio: What can you share about the study?
Gunaratnam: This was a follow-up to a previous study we did. When telemedicine launched in March 2020 with the onset of the pandemic it was a theoretical concept. We had never done telemedicine in our practice. But then everything shut down, and we had to do telehealth immediately. It was sort of a panic situation. None of us knew how to do it. We didn't know whether doctors would like it, patients could do it or if we could provide effective medical care.
At the height of the pandemic, we did a survey of 500 gastroenterologists and 1,500 patients and asked what they thought about telemedicine. More than 80% of physicians and patients liked it and felt it was an effective way to provide GI care. That was asked when we were just scaling this. Patients and physicians had never interacted that way, but still, 80% of the people were satisfied, which is good. That gave us some baseline reassurance that telemedicine was an effective way treat certain patients.
But now, as COVID becomes a little more controlled and vaccines are readily available, do we bring everybody back to in-office visits or does telemedicine still have a role?
In this new study, we created a setting in which some people are doing telemedicine, and some are coming in person, and we asked people who experienced both how they compare the two. Do you find one is better than the other? Do you like one or the other?
We found that more than 80% of people like it, and when we drilled down further, we found that people who are older than 60 years and retired prefer coming in to the see the doctor, and people who are younger than 60 years and working preferred telemedicine.
And that makes sense. Let's say you are retired, and you are in your 70s: Your vision of going to the physician has always been to drive to the office. You go, you sit in a waiting room, you are taken back, you have your blood pressure measured, and the doctor walks in. That is your whole mindset of what a doctor’s visit is. Whereas younger people who are working may be completely fine with video platforms.
In our field especially, GI history is extraordinarily important, and the clinical exam is important in a minority of patients. This study has really given credibility to the fact that telehealth is extremely important and effective in delivering GI care.
Healio: What do you think will happen to telemedicine once COVID-19 is more controlled?
Gunaratnam: Health care must change and evolve; health care technology is very antiquated. Telemedicine is an incredible tool. I hope that legislators will understand this innovation is one of the tools in our toolbox to help us provide better care for patients and to take it away would be a step backwards. Telemedicine improved access for those with less resources, and I think compliance improved. Some in-office visits force people to miss half a day of work, whereas with telemedicine patients can do it during a 30-minute break.
One of the issues that Congress is debating — and I think this is a reason they are not completely embracing telemedicine — is that they say it will suddenly increase the volume to 300 patients a week, and therefore it is going to bankrupt Medicare. That is a legitimate concern, but there is zero data to support that.
In our experience, we have not increased the volume of care, but we have shifted the methodology. Our next study is going to explore if we have changed the modality of care from in-person to telemedicine. Anecdotally we find compliance improves and no-show rates fall dramatically. Whether it is at home or at work, telemedicine increases the probability of patients following up. We are seeing that no-show rates, compliance with medications and compliance with follow-ups are much better with telemedicine.
Healio: Why do you think a hybrid model that includes both in-person visits and telemedicine should be considered in the U.S. health care system?
Gunaratnam: It is far more convenient, and it is cost effective. Compliance is going to be helpful, especially when you think about the demographics. The hybrid model allows us to get the diagnostic algorithm started sooner. In the old system, patients would physically come in with a concern, make another appointment in 4 weeks, then get examined and then see a surgeon. The experience goes from 2 months vs. something that is more on demand. If there is one good thing in health care that came out of COVID, it is telemedicine and the vaccines.
Healio: Do you think health care will cover telemedicine or will it be billed differently?
Gunaratnam: My hope is that will be covered in the same way that it was during the pandemic. The consumer clearly wants it. We have been doing this now for 2 years, and everyone is comfortable with it. The other thing is that providers have spent a ton of money upgrading infrastructure, hiring IT people, etc. To flush all that down the toilet makes no sense economically.
Also, there will probably be another COVID-like illness in the future. This gives us flexibility. I am hoping the legislators will see that consumers want it, that doctors want it and that it is great for health care. It is great for preventing disease, it is great for compliance, and it is cost effective. I hope telemedicine will continue.
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Press Release
Dobrusin A, et al. Poster: Patient perception of telehealth services compared to in-person office visits across multiple gastroenterology practices. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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