Why Telemedicine Is Good Medicine

It’s hard to believe now, but before 2020, it was uncommon for a patient to interact with their physician in any way other than in-person, face-to-face. Less than 3% of people enrolled in large employer-based health plans and less than 1% of those enrolled in traditional Medicare had ever used telehealth. Of course, the technology existed for video and telephone visits back then. But how the technology could be used, and what government payers and private insurers would reimburse, was limited to a small subset of clinical interactions. This was, in part, by the design of strict federal and state-based rules governing the use of telemedicine.  

But when the pandemic hit, the landscape changed. Under the national public health emergency declaration, many telehealth restrictions in the U.S. were temporarily lifted, and medical centers around the country quickly responded. The use of telemedicine skyrocketed to meet burgeoning patient demand for care. For example, before the pandemic, about 13,000 Medicare beneficiaries received telemedicine services in a week. In the last week of April 2020, that number had shot up to nearly 1.7 million.  

Telemedicine use has settled since that spike, but all told, the past three years represent one of the most significant expansions of digital health in U.S. history. And though we’ve only just begun studying the results, what we see so far looks promising.

Patients are engaged.

Even as COVID-19 restrictions relaxed, patients have continued to choose virtual visit options. In a 2021 survey from the U.S. Census Bureau, nearly one in four respondents said they’d used telehealth services within the past month. Importantly, patients also report that they are pleased with their experiences — with satisfaction rates as high as 86% — and are increasingly willing to use these platforms to receive their care. In particular, patients have cited time saved, improved access, and increased convenience as advantages of telemedicine. They also report positive experiences communicating with their health care providers on these platforms.

Telemedicine is helping patients be healthier.

An obvious drawback to telehealth is that clinicians cannot conduct a physical exam when interacting with patients from a distance. However, video visits and other virtual care options have proven to be effective tools for follow-up visits, medication adjustments, and monitoring chronic conditions. Studies show that patients who used telemedicine in addition to their in-person care experienced better outcomes than those who didn’t. For example, a study of primary care patients who had only in-person visits, compared to those who had both in-person and telehealth visits, found that patients in the second group were more likely to get their recommended screenings and tests. In another study of the first nine months of the pandemic, diabetic patients who participated in at least one telehealth interaction were more likely than those who didn’t use telemedicine to maintain their pre-pandemic levels of health instead of worsening. 

Telehealth can help us reach more patients.

These touch points with a clinician — however brief — can make a big difference to a patient’s health. But our health care delivery model has come to rely too much on patients traveling to clinics and hospitals, rather than bringing care to them in their communities. Telemedicine offers an efficient way to reach patients where they live — and for people in rural areas, where hospitals are unfortunately closing their doors at a rapid rate, bridging these miles can mean the difference between seeing a doctor and delaying much-needed care. 

That’s not to say the work is done. Video visits and other virtual care require access to devices, technology, and digital know-how that people in disadvantaged groups don’t always have. In building a telehealth infrastructure, we must find ways to advance equitable access and ensure our most vulnerable aren’t left behind. Fortunately, there are already promising signs. The Census Bureau survey found that the highest rates of telehealth use were among people with low incomes and Black adults — traditionally underserved populations — because these individuals were more likely to participate in visits via telephone. What’s more, when polled before the pandemic and after, Black adults were among the subgroups that reported the greatest increase in willingness to use a video visit.

Continuing the forward momentum of telehealth

We still have a lot to learn about how to best leverage these platforms, but we’ve come a long way in the past three years. Much of this progress is due to the suspension of decades-old parameters regulating how telemedicine is practiced. With states and the federal government poised to rescind their pandemic-related emergency declarations, many of those restrictions could again take effect — and in some states, they already have. It is my hope that, instead of reverting to our pre-pandemic status, we will use our current position as a starting point for telemedicine in the U.S., and we will continue to apply what we’ve learned to refine this delivery model to benefit even more patients.

These resources provide more information about the current state of telehealth in the U.S. and clinicians’ experience using these platforms for patient care.

Biden Administration Seeks to Expand Telehealth in Rural America (The New York Times). Last fall, the Department of Health and Human Services announced a plan to distribute nearly $20 million to rural and underserved communities to bolster telehealth services where some of the nation’s oldest and sickest patients live. 

Telemedicine works. But states are killing it off (NBC News). This opinion piece provides an overview of how state and federal COVID-19 public health emergency declarations enabled officials to temporarily waive restrictions related to telemedicine, and how the expiration of these declarations has meant that restrictions have been reinstated in many states.

Therapy for People Who Can’t Go to Therapy (The New York Times). This guest essay discusses the importance of equity considerations in expanding access to mental health care through telehealth services. 

Serving Patients Through a Screen (The Atlantic). In this opinion piece, a physician discusses her conversion from telemedicine skeptic to advocate after seeing how virtual visits can enhance the doctor-patient connection and increase patients’ engagement and comfort.