Will COVID-19 be a tipping point for telehealth in the U.S.?
Health care providers and government officials are urging Americans with COVID-19 symptoms to use telehealth services as they try to stem the flow of unnecessary visits to crowded emergency rooms.
More than 4,000 people in the U.S. have been diagnosed with the novel coronavirus and at least 71 people have died, according to the most recent data from the Johns Hopkins Whiting School of Engineering’s Centers for Systems Science and Engineering. In recent days, concern about the pandemic, which began in China’s Hubei Province, has worsened in the U.S. as store shelves were emptied, new travel restrictions from Europe implemented, and schools in half of U.S. states closed.
In preparation for the possibility of a surge in patients, hospitals and health insurers have promoted a combination of hotlines and video visits to people in their communities and networks. Elected officials like the California and New York governors have required insurers that operate in their states to offer telehealth services as part of their emergency declarations, prompting Cigna Corp.
and Humana Inc.
among others, to announce plans to do so.
It is also part of President Donald Trump’s national response plan. Last week he called telehealth a “fairly new and incredible thing that’s happened in the not-so-distant past” when the federal government waived rules restricting telehealth services provided across state lines.
“Doctors from other states can provide services in states with the greatest need,” he said Friday at a news conference.
That said, telehealth is a little used tool in the U.S., generating less than 1% of U.S. medical claims in 2018, according to a 2019 FAIR Health white paper. It is unclear how comfortable Americans, who are largely still loyal to the idea of in-person interactions with physicians, or the doctors who trained in an era without virtual care, are with using telehealth on such a large scale.
However, as some states and cities in the U.S. have moved toward some form of a lockdown to mitigate the impact of the virus and as the number of COVID-19 cases and deaths continues to rise, some clinicians say the pandemic may serve as a tipping point for telehealth in America.
“There’s this slow momentum that’s been building,” said Dr. Gary Greensweig, chief physician executive of CommonSpirit Health, one of the nation’s largest hospital systems. “And now with something like coronavirus, which is very amenable to telemedicine, we’re going to see it tip.”
Shares of Teladoc Health Inc.
a Purchase, N.Y.-based telehealth provider, have soared 47% over the past three months. Most of the main telehealth players including American Well Corp., Doctor on Demand Inc., and MDLive Inc. are privately held.
“If there is a long-term benefit, it’s pulling forward the adoption curve since more people would likely use the service than otherwise would not have without the outbreak,” Credit Suisse analysts wrote March 12. “This creates more awareness, [driving] further adoption and long-term utilization.”
During a March 5 investor day, Dr. Lewis Levy, Teladoc’s chief medical officer, outlined three reasons behind the use case for telehealth during the COVID-19 pandemic: preventing emergency rooms from being overcrowded, limiting exposure among health care workers to infected individuals, and lessening the use of masks, gowns and gloves for workers by keeping patients at home.
Dr. Judd Hollander, associate dean for strategic health initiatives at Thomas Jefferson University’s Sidney Kimmel Medical College, which is a customer of the company, told Teladoc investors that the hospital system is experimenting with telehealth in additional ways, including having providers use video calls to communicate with patients from room to room in a hospital setting. He also said if clinicians are quarantined but still able to work, they may be able to provide telehealth from their homes.
(Patients who are believed to have COVID-19 are expected to be immediately masked and placed in a room alone. If they are hospitalized, those patients are put in negative pressure rooms, which are set up to prevent air from that room flowing into the hallway when the door is opened.)
It is “almost like telemedicine was built to deal with this” pandemic, Hollander said.
Easing the financial side of the equation may also spur adoption. The Trump administration is waiving rules that restrict doctors from one state from providing telehealth services to a patient in another, while the Centers for Medicare and Medicaid Prevention said last week that if someone with Medicare with COVID-19 symptoms chooses a telehealth call in place of an in-person visit, that call is considered billable for clinicians. Aetna, which is owned by CVS Health
is waiving copays for all telehealth calls for 90 days, not just online visits related to COVID-19.
Some hospitals are already well into this process. The UCSF Medical Center launched a COVID-19 hotline in early February and is now directing people who call the hotline to a video call with a provider.
“While you can’t necessarily put a stethoscope on, you can tell by the way the patient is talking or what level of breathing they’re having,” said Gina Intinarelli, VP of population health at the UCSF Health hospital system in San Francisco. “You can hear if they’re coughing. You can hear the kind of cough, whether it’s productive or dry.”
In a March 13 viewpoint published in JAMA, Kaiser Permanente physicians wrote that video or phone calls between a patient and a clinician should be applied as part of social distancing efforts that are part of disease mitigation. “It is critically important that the strategy for slowing the spread of the COVID-19 pandemic change from containment to mitigation,” they said.