Policy Researcher: The Future of Telehealth Is Far From Guaranteed

Aug. 18, 2020
A healthcare policy researcher at the RAND Corporation shares her perspectives on the challenges of keeping the momentum around telehealth moving forward—and overcoming payment and policy obstacles

A senior policy researcher at the RAND Corporation has published an article in the Health Affairs Blog, in which she argues that healthcare policy leaders need to signal their longer-term intentions around telehealth earlier rather than later, in order to encourage the phenomenon forward.

Writing in the Health Affairs Blog online on Aug. 14, Lori Uscher-Pines, Ph.D., a senior policy researcher at the Santa Monica, Calif.-based RAND Corporation, writes in her article, “Moving On From Telehealth-By-Desperation: What Will Make Telehealth Stick,” that, even as “[T]o be sure, telehealth advocates are thrilled with the exponential increases in uptake,” in telehealth since the inception of the COVID-19 pandemic this spring, and even though “Surveys conducted in April 2020 suggest that up to 90 percent of physicians were offering telehealth visits in response to COVID-19,” and even though “The Centers for Medicare and Medicaid Services has announced that 22–30 percent of Medicare beneficiaries received telehealth services from March through June,” it is alarming that “[E]vidence is already emerging that telehealth use has peaked, and providers are starting to abandon it.”

Significantly, Uscher-Pines, who references that her husband is an emergency department physician, notes that “Providers told me in interview after interview that they transitioned to telehealth in March 2020 not because they were convinced of its value, but because they had to out of desperation. They needed to offer telehealth to offset the reduced demand for in-person care, keep their clinics afloat, and avoid exposing vulnerable patients to the virus. They felt a palpable ‘relative advantage’ of telehealth because in-person services could kill themselves, their patients, or both. The fact that we are now seeing a retreat from telehealth may be because providers never really embraced it in the first place. And with widespread re-openings across the country, and patients’ increased comfort with in-person care, providers can go back to what they know.”

Uscher-Pines notes that “COVID-19 disrupted the typical innovation life cycle in which providers would thoughtfully weigh the advantages and disadvantages of a large-scale delivery change in advance of its implementation. The pandemic didn’t allow providers the opportunity to pilot test and refine telehealth services prior to roll out, or to have much agency in the initial decision. Accelerating this life cycle helped providers surmount two major obstacles to innovation: lack of familiarity and resistance to change. Now that most US physicians have had a taste of telehealth, what still stands in the way of sustained use, and what can policy makers do to cultivate its growth?” she asks.

Unfortunately, Uscher-Pines states, because of the need to expand telehealth very rapidly during the COVID-19 pandemic, many physicians have found video visits “often difficult to implement due to challenges at the patient (for example, lack of devices or digital literacy) or clinic levels.” In fact, she notes, one-third of all telehealth visits in spring 2020 were audio-only (telephonic), despite providers’ clear preference for video visits.

The other major area of concern, Uscher-Pines notes, is that “Some physicians also expressed concerns over the quality of telehealth visits, such as an inability to conduct a physical exam. Although many appreciated the new flexibilities provided by temporary pandemic policy changes,” she notes, “concerns about quality and liability prevented them from taking full advantage of those changes.”

Alarmingly, Uscher-Pines reports, “[T]elehealth visits are already declining and may continue to decline unless states enter lockdown again. Without permanent policy changes, it is unclear if telehealth services ill represent a significant proportion of U.S. healthcare visits in the long run.”

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