Gabriel Perna | August 11, 2020
The surge in telemedicine usage is one of the biggest stories of the pandemic. Some organizations went from thousands of visits per month to hundreds of thousands, if not more.
While no one expects telemedicine to maintain that peak level, the tech has the support of providers, patients, politicians, and numerous other stakeholders. In a survey from DocASAP, 91 percent of consumers who have used the technology are likely to schedule a visit through telemedicine rather than an in-person visit in the near future.
Ann Mond Johnson, CEO of American Telemedicine Association, recognizes that telemedicine’s continued momentum is far from assured. The federal government, and numerous private insurers, temporarily relaxed restrictions around telemedicine reimbursement, making the technology more easily reimbursable for providers. Whether or not those relaxations will stay, however, remains an open question.
“We’re at this odd juncture where these waivers have to be made permanent. We have to make sure organizations don’t go over the telehealth cliff. The biggest concern from CEOs is the uncertainty associated with this and they’re hoping it gets resolved in quick fashion,” says Johnson. ATA represents a cross section of providers, telemedicine software companies and payers.
Johnson spoke with Health Evolution about her takeaways from the last few months, what has to happen to ensure telehealth is here for the long haul and more.
Health Evolution: What are your major takeaways from the surge of telehealth usage we’ve seen in the last few months?
Johnson: It’s been a crazy few months for sure. We’ve seen an incredible response from our membership. The diversity of our membership has been a strength of ours and allowed us to see collectively how the industry responded. When you talk about a surge, there were unprecedented increases. Providence, Intermountain and Partners Healthcare saw incredible increases. You’ve seen the data but it’s astonishing. Telemedicine usage among Medicare beneficiaries went up by more than 11,000 percent. Mass General went from 1,500 visits to more than 250,000 visits per month. Sixty percent of all ambulatory visits were done through telemedicine at the peak. This is important because as an industry, we proved we were able to deal with the surge. That included delivery systems using tools from Amwell and others, as well as the organizations that had an interactive assessment to help people help understand if their symptoms were COVID related or not. People were frightened and alone and didn’t know what to do. Technology, in many ways, saved the health system from collapse.
Health Evolution: What does the health care industry have to do to ensure this isn’t a fleeting trend because of the pandemic and is integrated into the delivery system over the long term?
Johnson: In the pre-pandemic world, we needed telehealth. There was a shortage of clinicians. There were significant wait times for primary-care physicians. Over 50 percent of counties in the U.S. didn’t have mental health specialists or services, yet one out of five people have a mental health issue. We had some real issues of access. What was laid bare with the pandemic was the fact we had this technology that increased someone’s likelihood to access care. It wasn’t enjoyed by everyone, but it certainly increased access.
From a long-term perspective, health care delivery systems have to continue to think in terms of how to meet customers where they are. You’ve seen companies like Walmart, Best Buy, CVS, and others who come into health care because they offer a consumer experience that’s pretty cohesive. Also, there has been some recent data from Accenture that shows trust in health systems has increased. As people seek guidance on their care, the trust in those institutions is an opportunity for them. And the other thing is making this easy to access. It’s incumbent on all of us to address the disparities and inequities laid bare by COVID. This is an opportunity on what we will do differently in terms of technology and how we can use it to overcome bias. You can have all the technology in the world but if you have people whose interactions don’t lead to good treatment, it doesn’t make a difference.
Health Evolution: One positive I’ve seen is that in a hyper-partisan world, telehealth is largely bipartisan. Why do you think that is?
Johnson: Ignoring the debate over whether or not we want an insurance or coverage system that’s Medicare for All, but fundamentally what we believe is all Americans need to have access to basic health care services. It’s not OK for people not to get health care, broadband access, and access to connectivity. Those things are not OK. That’s why telemedicine is increasingly bipartisan. It’s part of what makes it so exciting. We have been spearheading efforts with our members to ensure the waivers are made permanent.
Health Evolution: What work is the ATA doing to ensure telehealth stays a fundamental part of the health care system beyond COVID-19?
Johnson: The campaign we’re working on has two sides. One is on the policy and advocacy side at the federal and state level to identify what needs to be changed and what needs to stay. We’re being very guided and very specific in that. We wrote a letter to Congressional leadership a few weeks ago, with 340 signatures [from member organizations]. The letter itself was very specifically focused on certain asks. For instance, we requested that the originating site, federally qualified health centers and rural health centers, are able to provide telehealth going forward and get reimbursed for it. The campaign is focused initially on federal work, but also on the state level. There is legislation percolating among certain states that we’ll address with our members.
But at the same time, the campaign and work we’re doing is intended on the media and thought leadership side that we anticipated the questions and concerns of regulators and legislators. Meaning through qualitative research, we’ve demonstrated that telehealth is good, and that telehealth is health. We’re gathering specific stories people have told – patients to providers, providers to providers, patients to families – talking about how they use telehealth and the difference it’s made for them. But also through a rapid cycle of research. There have been lots of charts that have come out that show the incredible surge. It’s safe to say the drop in utilization, from what we hear from our members, is that it won’t go to the pre-pandemic levels. It won’t stay as high as it was before. It will probably sit around 30 percent at its peak. With that, we have to prove it’s effective, safe, and that the program integrity is there. That it’s no more subject to fraud than any in person interaction.