Local health experts say it's clear telemedicine is here to stay. But after seeing huge spikes in virtual visits in 2020, providers are evaluating what investments and policies are needed to help cement telemedicine as a permanent part of the health care delivery system.
Telemedicine visits soared in the last year amid the Covid-19 pandemic. Some health organizations that had never offered virtual care pivoted quickly to enable patients to visit their doctors via phone or web video, and even organizations that have been offering telemedicine for several years saw demand grow enormously.
For example, LifeBridge hosted a little over 2,000 telemedicine visits in January of 2020, largely to help triage visitors at the system's emergency departments. One year and a global pandemic later, LifeBridge hosted nearly 10,700 primary care visits via telemedicine, in addition to roughly 2,000 ER teletriage visits this January, according to Dr. Jonathan Thierman, the health system's chief medical information officer. LifeBridge saw its telemedicine usage peak in April at about 1,000 daily visits and since then, visits have leveled out at about 500 per day, Thierman said.
Another local health care provider, Kaiser Permanente, saw its volume of phone and video telehealth visits increase from about 15% of all visits before the pandemic to a peak of more than 90% last spring. In the last few months, the proportion of virtual visits has held at around 50%, the company said.
Thierman said LifeBridge expects a significant portion of health care will be delivered virtually for the foreseeable future. He and other local executives weighed in on some of the steps ahead.
Investing in more digital health technologies
Dr. Richard McCarthy, executive medical director for mid-Atlantic states for Kaiser Permanente, said that while Kaiser has been doing telemedicine visits for several years, the company is now investing more heavily in new technologies and enhancements to address heightened demand. Kaiser has made several updates to its website and app to make them more user-friendly and accessible for all patients, including those who need language interpreter services. It has also launched new telemedicine options, such as "Video Visit Now," which allows patients to receive on-demand video care within 15 minutes.
LifeBridge will also be making further investments into its telemedicine infrastructure, which Thierman said has been "pushed to the limit" over the past several months. The changes will increase bandwidth and technical capabilities to accommodate more volume and traffic on LifeBridge's telemedicine platforms.
He said the system is also looking into new technologies and apps that can enhance the digital patient experience, including by helping to evaluate a patient who is recovering at home following treatment. The system will also be increasing human resources behind telemedicine, with plans to hire a digital health director and to continue expanding its team of full-time physician assistants who support LifeBridge's virtual hospital.
Acclimating doctors and patients to the new normal
Dr. Robert Boughan, medical director of Mercy Personal Physicians at Lutherville, said because Mercy Health did not use telemedicine prior to the pandemic, implementing it over the past year has involved a serious learning curve. Most patients have been "extremely receptive" to the new mode of care, he said, but some physicians are still learning the tech and figuring out how to best evaluate their patients via video screen instead of in person.
Thierman said although most patients have happily embraced telemedicine, many are still acclimating to the new method of care. He noted that some patients find it odd when LifeBridge representatives call them directly during off hours to schedule appointments or conduct follow-ups for telemedicine visits. Some have even worried such calls are part of a scam.
"They are suspicious sometimes because they aren’t used to that level of service, and certainly aren’t used to being called by their physician on a weekend," Thierman said. "I think eventually that kind of attention and care will become expected, but patients aren’t quite used to it yet."
Lowering cost and policy barriers
Insurance reimbursement for telemedicine has been greatly expanded during the Covid-19 pandemic, including through the federal CARES Act. Thierman said it is important that insurance coverage for virtual care continues to be a policy priority for government leaders and private insurance carriers, so that patients can continue to have increased access to care and doctors can still get paid.
McCarthy said he hopes as insurers and lawmakers continue to evaluate reimbursement models, cost barriers can be further reduced. He noted, for example, that Kaiser has always offered virtual visits to patients without any copays.
Thierman also hopes to see a shift in licensure requirements for doctors delivering virtual care across several states. In order to practice medicine — even virtually — across multiple states, doctors must get practicing licenses for each individual states. The cost and effort to gain multiple licenses to deliver the same kind of care across state lines amounts to "tens of thousands of dollars and lots of paperwork," Thierman said.
"It's really a barrier to care," he said. "A doctor in Maryland should be able to provide telemedicine care in Virginia or some other state without that hurdle."