One of the big stories emergent from the current COVID-19 crisis is the rapid growth of telemedicine. Hindered in the past by regulations as well as custom, telemedicine has, until recently, only occupied a small niche in the healthcare industry. Commercial and government payers feared rampant fraud while healthcare providers and patients enjoyed the status quo. The current pandemic changed all that very quickly. Providers needed to conserve personal protective equipment and patients were justifiably fearful of visiting medical practices/facilities and either catching or spreading the illness. Meanwhile, the government loosened regulations governing telemedicine and payers beefed up reimbursements. According to the McKinsey COVID-19 Consumer Survey dated April 27, 2020, consumer adoption has skyrocketed, from 11 percent of U.S. consumers using telehealth in 2019 to 46 percent of consumers now using telehealth to replace cancelled healthcare visits.
“Providers going forward will incorporate telehealth into their delivery model; patients will demand it,” predicts a Memorial Health System executive. “Technology will expand rapidly. Regulations will come back; but now that telemedicine has been so broadly implemented, the government won’t be able to stop it,” he added.
“The original telehealth model was an add-on to brick and mortar care,” states a Baptist Health South Florida affiliated MD. “Now the call to action is to establish a new type of care for patients.”
And it’s apparent that many will join in the effort to heed that call. A recent report published by McKinsey and Company predicts that accelerated growth could vault the U.S. telehealth business to $250 billion. So, clearly this is a compelling business opportunity but what about the consumer?
A well-deserved complaint about U.S. healthcare is the poor value. It’s well documented that the U.S. spends the most per capita of any developed nation with middling outcomes. Because of its inherent efficiency – delivery of virtual medical encounters is cheaper than face-to-face encounters – telemedicine has the potential to alter the value proposition for the American healthcare consumer.
Further, both the patient experience and positive outcomes could be boosted by wider adoption of the telemedicine model.
“There is propensity to be more vulnerable when visiting doctors’ offices or medical facilities – it’s very demanding on your time and stressful,” according to Mario Espino, CEO of MDsOnDemand.com and CCMS-ACO, a primary care group virtual practice based in North Miami Beach. “Obviously, there are conditions that should be treated as telemedicine and those that should not,” he adds. “Regardless, those patients that are frail and immunocompromised should use telemedicine to the extent that it is the right care environment. What you can’t quantify is: How many patients become sick because they went to the doctor’s office, emergency room or urgent care?”
However, there continues to be several potential roadblocks to successful, ongoing and widespread use of telehealth services.
Fraud and abuse by unethical providers and digital security issues remain top concerns. And for good reason. Telemedicine fraud can become massive because phone rooms operating anywhere in the world can target thousands of patients and Medicare may have difficulty differentiating improper bills from those submitted by a legitimate telehealth operation, according to Kaiser Health News reporter Fred Schulte in a recent article entitled Coronavirus Fuels Explosive Growth In Telehealth – And Concern About Fraud. Meanwhile, the increased utilization combined with security vulnerabilities will lead to more and more hackers targeting remote monitoring and medical devices. This could be dangerous – even lethal – for users, according to Natali Tshuva, CEO of IoT security company Sternum,
Patient safety can be impacted in other ways. While obviously some patients benefit from a virtual encounter, others would be better served by a face-to-face encounter.
“With telehealth having it’s moment and clinicians, healthcare business professionals and even payers all jumping on the bandwagon, it’s fair to wonder whether some patients might suffer a bad outcome because they weren’t seen in person,” states Rich Lucibella, President of Accountable Care Options of Florida, based in Boynton Beach. Mr. Lucibella points out that the medical standard of care – a critical component in med mal cases – is not yet clearly defined in the relatively new telehealth environment. “When must be seen in person?” queries Lucibella. “The guidelines don’t exist at the moment but something needs to be developed to ensure the telehealth boom doesn’t yield negative unintended consequences including patient suffering and death. And of course, litigation.”
And it’s no secret that the COVID crisis has led the nation into an economic downturn. “Economic desperation drives many lawsuits,” states Matt Gracey a medical malpractice insurance specialist based in Delray Beach, FL.
Fraud and abuse, digital security vulnerabilities, patient safety and professional liability all present profound challenges. But that $250 billion figure is sure to attract the best and the brightest to meet those challenges.
Despite the risks, most providers are extremely optimistic about the future of telemedicine. “It’s going to be part of the mainstream,” according to a veteran South Florida based health system executive. “The quality of a telehealth visit will equal or exceed a traditional visit.”