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The business of telehealth: Coronavirus crisis brings clarity

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Courtesy of Greg Hartwell
Telehealth allows patients to receive a variety of health-related services remotely over the internet.

The Affordable Care Act was signed into law a decade ago, ushering in what many hoped would be a transformation of health-care delivery in the U.S. For a variety of reasons, while the law did expand access to health care, it didn’t spawn a great deal of innovation in a sector of our economy that badly needs it. Government regulations, bureaucracy and entrenched business interests continued to prevent ingenuity and creativity from revolutionizing – or evolutionizing – health care for the benefit of consumers.

One such area of health-care innovation is telehealth, which has been technologically available since the ubiquity of the internet and smartphones. In essence, it allows patients to receive a variety of health-related services digitally over the internet – education, prevention, clinical diagnosis, intervention, ongoing care and monitoring – remotely from professionals located anywhere in the world.

But the business of health care is slow to change, because it is so heavily regulated, driven financially by Medicare and large insurance companies and influenced politically by lobbying groups like the American Medical Association. As a result, the internet revolution has had little visible impact from the end-user patient perspective.

Necessity, the mother of invention

What could not be made possible by the most sweeping legislation of a lifetime may ironically be thrust to life by accident as a result of the coronavirus. Suddenly the threat of widespread contagion changed our mindset from the muddied gray middle ground that blocked progress to the black and white of saving lives. Overnight, bureaucratic regulations and selfish interest gave way to the real purpose of health care: to prevent the spread of the virus and ultimately mass fatalities to our most vulnerable sector. Life and death decisions often bring that type of clarity.

In March, Medicare temporarily relaxed federal rules for telehealth on reimbursements and HIPAA regulations, which opened the floodgates and allowed medical service providers to reach out to their patients remotely and bill for it. Physicians previously resistant to video visits found their offices empty and were forced to practice telehealth to keep afloat once it became reimbursable. This allowed for patient visits as simple as a FaceTime call between patient and physician, which previously had not been reimbursable or allowed by HIPAA.

Telehealth visits exploded exponentially across the country, preventing spread of the virus, saving lives among the hardest-hit COVID-19 fatality demographic of ages 65 and up, and showing the power of telehealth in a way that couldn’t have been demonstrated without the crisis.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said, “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

What the future holds

The promise of telehealth has always been a great one. It is a big win for all parties involved – health-care service providers, payors (Medicare, Medicaid or private insurance) and patients.

For the past couple of years, hospitals and skilled nursing facilities have been discharging elderly clients with telehealth services that combine technology to monitor symptoms such as vital signs that are analyzed by both artificial intelligence and clinicians that enable them to intervene on a timely basis to prevent hospital readmissions and redirect patients to their primary-care physicians instead of the hospital emergency room. The cost savings are enormous when you consider the astronomical financial cost of a single day’s stay in a hospital. When you consider that nearly 50% of all health-care spending occurs after the age of 65, telehealth has the potential to dramatically reduce costs in this target segment of the population.

I can envision a future where at some point Medicare provides the standard equipment to each enrollee to access medical services from their preferred providers that will focus on health and wellness, preventive services, treatment for chronic diseases, diagnostic monitoring and a variety of services that are only available now by visiting a physician’s office, clinic or hospital.

The financial stakes are high and the patient benefits are so substantial that medical services that previously seemed infeasible may finally be accessible. Imagine mental health services suddenly becoming available due to relaxation of regulations that prevent delivery across state lines. Medical bottlenecks will disappear and outcomes improve. Best of all, patients will take control of their own health and drive their own outcomes. As the Greatest Generation gives way to the aging baby boomers that are more accustomed to technology, those possibilities become more real.

Sensible deregulation or relaxation of Medicare reimbursement rules as well state regulations that open up access to telehealth will spur innovation and save money. Fears of fraud and abuse are real and must be monitored, but the benefits and learning will outweigh those risks.

It was never a matter of if telehealth would take off – it was a matter of when. Many service providers fear that once the coronavirus fears subside, government regulations will creep back into place, stifling the advances made. But it took a crisis of grand scale to shock us into finally taking action, and I predict there’s no turning back. I hope regulators have the good sense to prevent a return to old, entrenched ways limiting the delivery of health-care solutions.

It’s time to unleash the innovations that we all hoped would happen under the Affordable Care Act. We’ve waited a decade. Let’s not waste this latest tragedy to make it stick once and for all.

Greg Hartwell is founder and managing director of the Los Altos-based Homecare California. For more information, call 324-2600, ext. 105, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit homecare-california.com.

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