Telemedicine shines during pandemic, but will glow disappear?

Racked by fear, Lauren Shell had to talk to her cancer doctor.

But she lived at least an hour away and it was the middle of her work day. It was also the center of a pandemic. Introducing Telemedicine.

The 34-year-old Leominster, Massachusetts resident, arranged a quick video visit via the Zoom app in May with her doctor in Boston. He assured her that he was confident in her treatment plan, and the chances of her breast cancer returning were low.

“It was really great to talk to him about how I felt,” she said. She then felt comforted “knowing I was not alone.”

This is how doctors and researchers of health care are proposing telemedicine that emerges after the COVID-19 pandemic disappeared. They see the practice – which has grown explosively this year – tends to replace many visits in person and become a larger part of routine care.

Imagine more contact with doctors or nurses, but less travel to the office. Patients may use telemedicine more for check-ins like Shell did or for talking to a doctor after a procedure or getting a second opinion. There are also secure messages for quick questions and more remote control of chronic health problems such as diabetes.

“Your care will improve,” said Dr. Thomas Lee, a Harvard professor and healthcare expert at health care consultant Press Ganey.

But in order to grow something of telemedicine, thorny questions about insurance coverage and reimbursement of doctors need to be resolved.

Plus, patients and doctors who were forced to try virtual care during the pandemic will have to continue using it.

Doctors shuddered to switch to telemedicine when the coronavirus hit the US earlier this year. Healthcare providers such as the Cleveland Clinic went from an average of 5,000 telemedicine visits a month before the pandemic to 200,000 visits in April alone.

Many insurers waived fees to encourage use. The federal government has relaxed restrictions on the use of telemedicine in Medicare, the federal coverage program for people 65 and older. The government also began temporarily allowing visits to apps that did not meet patient privacy standards.

That helped Dr. Jay Meizlish connects with his most elderly heart patients. First they fought. He often had to hold cards up to his camera, telling patients to mute their microphone or turn up their volume.

Then he found something worked – he switched to the more familiar and easier-to-use FaceTime.

“That’s what they talk to their grandchildren,” said the doctor at Yale New Haven Hospital.

“We have learned the power of this, but whether it continues is not in our hands,” he said.

Experts expect that some restrictions on telemedicine will return, including fees that now vary. And some doctoral practitioners will be reluctant to work telemedicine permanently on their practices until they know exactly how they will be paid, noted John League, a senior consultant at Advisory Board, which researches health care strategy.

“They have no appetite for uncertainty,” he said.

Insurers will eventually cover more remote care because it can help keep people out of expensive hospitals and emergency rooms, said Arielle Trzcinski, a senior analyst at Forrester, who conducts research for insurers and hospitals, among other clients.

Insurer Oscar recently announced that it will offer free visits to primary care through telemedicine in coverage starting next year. Leaders in Washington are also interested in expanding the use of telemedicine in Medicare.

Trzcinski also thinks that doctor groups will provide more virtual care, because patients who visited it during the pandemic may go somewhere other than themselves. With travel and time in the waiting room, an office visit can on average take more than an hour and a half a day from someone, she said.

“People value time,” she said.

She estimates that virtual care can eventually replace up to 40% of personal doctor visits that do not include hospital stays.

Shell, the cancer patient, said she could never have visited her doctor in person that day. She teaches veterinary science at a vocational school. This makes it difficult to break away for an appointment from a doctor.

She was removed telemedicine several times due to the pandemic. She hopes the exercise continues.

“I strongly feel that increased security, convenience and accessibility are all reasons to continue,” she said.

Researchers do not expect telemedicine to replace all care for individuals. Millions of people do not have access to the technology as a reliable internet connection. Some people may still be intolerant of using it.

And not all diseases can be treated remotely.

Alexandra Thomas visited last spring when she woke up from vertigo which made her so dizzy that she could barely walk. The nurse who treated her virtual visit wanted Thomas to see someone in person. That meant the 24-year-old Charlottesville, Virginia resident had to spend another $ 30 on a copy and wait another three hours at a clinic before being treated definitively.

Telemedicine, Thomas said, is “a good idea in theory, but perhaps not so much in practice.”

Doctors see that it plays a bigger role for people with chronic conditions. More patients with diabetes can check their blood sugar at home, go to a blood draw laboratory and visit their doctor once a year instead of every three to six months.

Lee, a Harvard professor, said doctors are moving to caring for patients as efficiently as possible. The pandemic accelerated this pressure.

“I just think there will be no going back,” he said.

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Follow Tom Murphy on Twitter: @thpmurphy

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.