Telemedicine Crushed It in 2020. Will the Service Be Just as Amazing in 2021?

By: | April 21, 2021

Terri L. Rhodes is CEO of the Disability Management Employer Coalition. Terri was an Absence and Disability Management Consultant for Mercer, and also served as Director of Absence and Disability for Health Net and Corporate IDM Program Manager for Abbott Laboratories.

The pandemic has changed a lot of things — online shopping, at-home entertainment, work arrangements, take out and food delivery — and telemedicine.

Advancements in computers, phones and artificial intelligence made telemedicine possible years ago; however, policy stood in the way of activating it.

It took a pandemic and relaxed federal government regulations to enable implementation. Prior to the pandemic, almost one third of provider organizations did not utilize telemedicine.

Then in March 2020, the country all but shut down. In April, visits for outpatient care had fallen nearly 60%. If medical visits, including mental health, were to continue at all, telehealth had to expand. Doctors, therapists and employers adapted.

Medicare began compensating physicians for a broader range of telehealth services, and enforcement of certain HIPAA restrictions were effectively waived — allowing doctors to treat patients and prescribe medication using the Internet of Medical Things.

A year later, telehealth is now an accepted and established part of the U.S. health care system. According to a report from Rock Health, live video telemedicine was used by 43% of patients in 2020.

As is the case with other online technologies, adults 35-54, higher-income earners, highly educated individuals and those with chronic conditions were the early adopters. Individuals who were 55 and older, located in rural areas, and who had limited education were less likely to use telemedicine.

Changes in Insurance Coverage

The accelerated adoption of telehealth has been met with changes in insurance coverage — including those mandated by the government. For example, West Virginia introduced a bill in March that would require insurers to cover the same services for telehealth they would cover in-person beginning in July 2021.

If passed, it would be the first such law in the state.

In Arizona, a 2020 law mandates commercial insurers cover more forms of care via telehealth — such as remote patient monitoring and asynchronous visits. Payers must also cover telemedicine visits from all specialties, according to legislation that went into effect this year.

With these and other new laws, all but seven states now have some requirement on the books for how commercial insurers should cover and pay for telehealth.

New Opportunities for Collaboration

Telemedicine has not only helped insurers and patients; it has also helped the health care industry during the pandemic. Telemedicine technology has made it possible for doctors and hospitals to collaborate with one another in new ways and pool resources at critical times.

Banner Health, a nonprofit system of hospitals in six states, saw a rush of COVID-19 patients in 2020. The organization worked with Intel and the telehealth platform VeeMed to bring advanced telemedicine software to over 1,000 in-room televisions across Banner’s 28 facilities.

This allowed specialists in infectious disease, pulmonology, critical care, cardiology and nephrology to see more patients without risking transmission.

Telemedicine may also be an answer to upcoming health care challenges.

As more than half a million registered nurses are predicted to retire by the year 2022, telehealth could help ease this drop-off of on-site personnel by allowing physicians, and even nurses in different locations, to provide medical support to patients virtually. This means more remote health care positions could become available — opening new opportunities for those entering the health care industry.

Advantages for Employers

Telemedicine also has advantages for employers.

Less time away from work means higher productivity. And while it’s still too early to tell, increased convenience could lead to more utilization of the kind of care — preventive and mental health — that reduces absence and other costs.

This is especially the case with therapy and counseling. The proliferation of employer-provided stress management resources, including phone apps, has made mental health-related care easier than ever to obtain.

It’s also likely reduced real or perceived stigma. Any increase in the utilization of mental and behavioral health resources is good news for increased productivity and reduced absence, disability and total employer health care costs.

Telemedicine and the Future Workforce

If we have learned anything from this pandemic and the resulting shift to telemedicine, it is that we need to pay attention to the future of our workforce.

According to the Pew Research Center, millennials make up 73 million of the U.S. population. According to several studies, they have trust issues with the health care system, and they tend to look for faster responses that leverage technology such as self-service portals, online appointment scheduling and telemedicine.

The studies indicate the following about millennials:

  • 77% have used a phone to find information about a health condition.
  • 74% value being able to schedule their appointment through a mobile application.
  • 64% would be open to virtual care treatment options as an alternative to in-office visits.
  • 52% would choose a primary care physician who offers virtual care treatment options over one who does not.

The Continued Role of the Federal Government

The federal government will also continue to play a role, especially when it comes to leave and disability. Last year, in a major move, the U.S. Department of Labor (DOL) issued COVID-related guidance that, under certain circumstances, telemedicine is the equivalent of an in-person visit.

On Dec. 29, 2020, the DOL made this permanent for determination of eligibility under the FMLA. To be considered an in-person visit, a telemedicine visit must be an exam, evaluation or treatment by a health care provider; be permitted and accepted by state licensing authorities; and should be a video conference.

In the first session of the 2021 DMEC Virtual Compliance Conference in March, the DOL’s Helen Applewhaite reiterated that this change is permanent.

Not all is rosy though; there are some disadvantages of telemedicine. Telemedicine may not provide a full view of an illness or injury. There is a potential risk of missing minor signs and symptoms, which can lead to incomplete or inaccurate results.

The telehealth policies and reimbursement rules associated with the industry are still developing. Privacy concerns, difficult-to-use software, poor internet/phone connections and loss of power can impact use and satisfaction.

Even though significant strides have been made, there are still challenges for patients and health care providers who are interested in adopting telemedicine practices.

Overall, the advantages outweigh the possible disadvantages. More investment by both the private and public sectors — including increasing broadband in rural areas and educational efforts among patients who may not know about or trust remote medical care — are needed.

Given telemedicine’s low risks and high rewards, those investments and outreach programs are almost certainly on the horizon. For employers, this will mean new ways to deliver health care to their employees and changes in how absence and disability is managed. &

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