'Strong magnetic forces' are pulling care back into brick-and-mortar, in-person settings, said telehealth champion Joseph Kvedar.
With pandemic case rates plummeting, telehealth has reached a fork in the road, and one of the industry's leaders is worried about it.
"The choices we make in the next few months, all around the industry, are going to pave the way for the next decade," said Joseph Kvedar, MD, chair of the American Telemedicine Association (ATA), who is also a professor of dermatology at Harvard Medical School.
"We might not be able to resist that strong magnetic force that draws us back to in-person, brick and mortar," Kvedar said, as his keynote address opened the 25th annual ATA conference, being held virtually throughout June.
"I keep hearing themes of things that are drawing [providers] back into brick and mortar," Kvedar said. "I constantly hear about things like 'our folks want to charge facility fees, or we have beds to fill.
"We are like hotels. We have to fill our beds to make a living.' And that's challenging us to think about how we go into this two-channel hybrid world."
Already, data Kvedar cited show a pullback from the rich mix of virtual visits that peaked during the height of the COVID-19 pandemic. From March to June 2020, 30% of all U.S. outpatient activity was conducted via telehealth, in contrast to 0.8% in the same time period during 2019, according to FAIR Health, an independent nonprofit that collects data for and manages the nation's largest database of privately billed health insurance claims and is entrusted with Medicare Parts A, B, and D claims data for 2013 to the present.
By August 2020, that activity had declined to 6%, and it remains at 5.9% as of February, Kvedar said. "So there does appear to be a leveling off, or a slight decrease" in such telehealth use, he added.
According to a different source, The Commonwealth Fund, 14% of outpatient visits were telehealth in April 2020, then leveled off at 7% in August 2020, a figure that has remained stable since then.
Kvedar said physician mindsets are part of that pullback to in-person care.
"I'm a dermatologist, so I see my share of acne patients," he said. "Acne is a perfectly great use case for telehealth. If I see a patient on telehealth, I'll offer them telehealth as a follow-up. If they come to me in the office with the same condition, and I'm not thinking about it, I probably offer them office-based care as a follow-up, because that's just the way my brain's working in the middle of a busy day."
Looming behind these statistics is the continuing doubt that payers will continue to cover the cost of telehealth visits. "The reimbursement future is uncertain," Kvedar said.
(Joseph Kvedar, MD, is the chair of the American Telemedicine Association. Photo courtesy of American Telemedicine Association.)
In particular, telemedicine advocates need to get the originating site rule of section 1834(m) of the Social Security Act changed, he said.
"This is a Medicare law that requires that Medicare patients be in a health profession shortage area to access healthcare via telehealth," Kvedar said. "If we don't get that changed, that will create an ice age for telehealth reimbursement."
If value-based reimbursement models expand, that will boost telehealth's prospects as well, he added.
Another concern of providers is that consumer tech companies will come in and "take over primary care," Kvedar said. "But yet I hear that [providers] are pulling back to brick and mortar, so how do we deal with that conundrum?"
Kvedar said telehealth advocates "need to be much more blunt and come up with financial reasons for providers to take the risks of going big, and telehealth going big in hybrid [settings], because right now there's this tendency to pull back."
In that vacuum of traditional provider leadership on the issue, national telehealth providers, such as Teladoc and Amwell, may become the dominant players in telehealth, Kvedar said. He cited data showing that telehealth care from local providers surged during the pandemic but has since swung back toward these national telehealth providers.
"It may very well be that you see the provider side to a brick-and-mortar dominant way of providing care," he said.
Kvedar urged ATA attendees to "advocate, advocate, advocate," writing letters to legislators calling for more access to telehealth. He also urged employees to similarly advocate to their employers, and for health plan members to encourage health plans "to reimburse in a straightforward, thoughtful way that isn't confusing telehealth."
He also urged telehealth technology suppliers to "double down on any innovation that increases our efficiency, whether it be symptom checkers, chatbots, home devices, social robots, anything that enables us to take a human being and use that individual's time across multiple patients or populations." He also reiterated the ATA's call for universal broadband service.
“We need to be much more blunt and come up with financial reasons for providers to take the risks of going big and telehealth going big in hybrid [care], because right now there's this tendency to pull back.”
Joseph Kvedar, chair of the board, American Telemedicine Association
Scott Mace is a contributing writer for HealthLeaders.
Some data show outpatient telehealth use peaked at 30% in 2020 and has now leveled off at around 6%.
Revision of Section 1834(m) of the Social Security Act must occur to ensure telehealth reimbursement, Kvedar said.
Use of national telehealth providers such as Teladoc and Amwell was less dominant during the pandemic, but use has swung back their way since then.