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  • The novel coronavirus pandemic has stretched health care systems to the

  • brink. Covid-19, might be getting all the headlines, but patients are

  • still getting sick from other diseases and injuries.

  • And that's left doctors looking for other ways to treat them while

  • minimizing contact.

  • Enter telemedicine.

  • Telemedicine is broadly defined as the use of electronic communications

  • and software to monitor and treat patients in lieu of an inpatient visit.

  • Over the past decade, telehealth, a broader term used to define all

  • medical services and health education delivered digitally, has grown

  • steadily as an industry.

  • According to IBISWorld, the industry's revenue has grown 34.7 percent from

  • 2014 to 2019.

  • The market size in 2019 was around 45 billion dollars, but it's projected

  • to grow to more than 175 billion dollars by 2026.

  • Despite the increase in revenue, Americans have been slow to adopt the

  • practice. According to a 2017 study, 82 percent of U.S.

  • consumers don't use it.

  • Like all of American life, that changed with the novel coronavirus.

  • The number of Medicare patients using telehealth has increased from roughly

  • 11,000 a week to more than 650,000 people a week.

  • It's led to a surge in usage for telemedicine companies such as Teladoc and

  • American Well. And video conferencing company Zoom, whose stock is up more

  • than 150 percent since the start of 2020.

  • Shares of Microsoft, which owns video conferencing software Skype and its

  • teams platform, are up more than 14 percent since the start of 2020.

  • Telemedicine visits surged to 50 percent in March and are on pace to reach

  • 200 million by the end of 2020.

  • That's up from earlier predictions of 36 million America's health care

  • system has skipped the test run and jumped to using telemedicine as a

  • primary means of care during the coronavirus pandemic.

  • Here's how coronavirus could change the future of U.S.

  • health care.

  • Telemedicine dates back to the mid 20th century when radios were used to

  • provide medical advice on ships.

  • In hospitals, the first usage was in the 1950s through a closed circuit

  • television link for psychiatric consultations.

  • In the last 30 years, telemedicine treatment has expanded to mental health,

  • stroke and patients with chronic diseases like asthma, diabetes or heart

  • failure. A number of research studies have found it to be an effective

  • alternative and satisfying for both the patient and provider.

  • Telehealth proponents have sold it as a solution for patients in rural

  • areas. Now they advocate it as a low cost and convenient option for tech

  • savvy millennials and busy parents as well.

  • A 2019 American Well study found that 66 percent of Americans are willing

  • to use telehealth, but only eight percent had already tried it.

  • Dr. Michael Barnett is an assistant professor of health policy and

  • management at the Harvard T.H.

  • Chan School of Public Health and a primary care physician at the Brigham

  • and Women's Hospital in Boston.

  • He's published papers about telemedicine adoption in the U.S.

  • There are many different reasons why the use been so low.

  • The first is that insurers are very worried that people would use too much

  • telemedicine if they covered it too easily.

  • And so there are lots of restrictions on the kind of telemedicine visit

  • that insurers will pay for.

  • So, for example, Medicare, which is the big federal government payer that

  • covers older adults and the disabled, they only pay for telemedicine if

  • somebody is a rural resident.

  • And you also have to go to a specific kind of facility with a specific

  • kind of equipment and has to be a doctor that you've already seen.

  • In addition to that, in the U.S., I think people are really quite attached

  • to seeing their doctors in person.

  • Doctors or, also, their business model is very much tied to seeing

  • patients in the office.

  • So they don't have a lot of incentive to offer telemedicine because there

  • isn't really a whole lot of patient demand.

  • So when the government announced that they would lift telehealth

  • restrictions for Medicare, it was a big deal.

  • Today, we're also announcing a dramatic expansion of our Medicare

  • telehealth services.

  • Medicare patients can now visit any doctor by phone or video conference at

  • no additional cost, including with commonly used services like FaceTime

  • and Skype. The move paved the way for private insurers and others to waive

  • their restrictions. However, the new exceptions didn't void requirements

  • states might have for telehealth.

  • Telemedicine has been cast as a tool to protect medical professionals from

  • exposure to Covid-19, to help reduce reliance on personal protective

  • equipment and keep the vulnerable and healthy at home.

  • Now, coronavirus could boost telehealth interactions to one billion by the

  • end of 2020. Telemedicine companies like Teladoc and American Well have

  • seen a big boost in users during the coronavirus pandemic.

  • They've been able to meet demand thanks to most states temporarily

  • modifying their license requirements for doctors, meaning a doctor in one

  • state can diagnose a patient in another state.

  • That's led Credit Suisse listing Teladoc as one of their top 10 investment

  • ideas amid Covid-19.

  • Berenberg Capital Markets predicts the company's market opportunity can

  • only head upwards.

  • And William Blair has called it the only clear beneficiary of the Covid-19

  • outbreak in our universe.

  • Even tech companies are entering the telemedicine space.

  • Here's CNBC reporter Cristina Farr on the growing overlap between health

  • and tech. So all of the major tech companies out in Silicon Valley have

  • been interested in telemedicine now for years and have been studying ways

  • to incorporate it into their products.

  • Microsoft, for instance, has been developing chatbots, has collaboration

  • software like Teams.

  • They also have video conferencing services.

  • Same with Apple, same Google.

  • And increasingly, they're finding ways to point people to use these sorts

  • of services. While

  • telemedicine on paper looks like a near perfect solution for policymakers.

  • It isn't always the best solution for providers or patients.

  • Dr. Jessica Bender is a primary care doctor and a clinical instructor of

  • medicine at the University of Washington.

  • Telehealth is not for all issues.

  • We want to provide the right care to the right patient at the right time.

  • Some medical issues just cannot be resolved over the phone or over video

  • and require an in-person visit.

  • Doctors are not always paid the same amount for a virtual visit as they are

  • for an inpatient visit.

  • As of December 2019, only 10 states pay the same amount or have what they

  • call payment parity laws.

  • There are a number of states that have passed so-called parity laws that

  • basically force insurers to pay the same amount of money for a

  • telemedicine visit as an in-person visit.

  • And the fact that telemedicine pays less than in-person visit is another

  • reason why it's been adopted less because not only are there all these

  • requirements for whether you get paid or not, but also in many situations,

  • doctors may not get paid as much for doing the same service.

  • Additionally, to access telemedicine services, patients need reliable

  • Internet access. And according to a 2020 Broadband Now study, 42 million

  • Americans don't have access to a wired or wireless broadband connection.

  • Telehealth has a risk of exacerbating pre-existing inequities in health

  • care, in either access to care or in health outcomes.

  • We talk about something called the digital divide.

  • So large parts of the country are rural and may not have access to high

  • speed internet, for instance.

  • Many of my patients who I see are unhoused.

  • They don't have phones, they don't have Internet or they might not have a

  • safe place or private place to be for a visit.

  • And so if we leave those folks out of our approach to telehealth, we will

  • just make health inequities worse.

  • In the U.S., more than 50 health systems such as the Cleveland Clinic of

  • Ohio and Mount Sinai in New York City have telehealth systems to conduct a

  • virtual check-ins with patients.

  • While most health systems have been able to quickly adapt, there are still

  • ways to improve. We're seeing hospitals start to strike these deals with

  • telemedicine companies.

  • Right before the pandemic, we saw Cleveland Clinic, for instance, a big

  • medical institution, sign a deal with American Well, one of the largest

  • telemedicine providers.

  • And that's true across many of these large hospitals that have gone from

  • having some kind of telemedicine option that's available, but very few

  • people know about it. To now pushing telemedicine front and center,

  • marketing it, emailing it, putting it right up on their websites for

  • people to use, really trying to make sure that they are aware that the

  • option exists. Massachusetts General Hospital, one of the top hospitals in

  • the United States, has been using a mix of existing and in-house platforms

  • to meet care. Dr.

  • Lee Schwamm is the Director of the Center of Telehealth at Massachusetts

  • General Hospital and the Vice President of Virtual Care at Partners

  • HealthCare. In the beginning of March, before Covid really came to us,

  • maybe four weeks ago, we did about somewhere between 0.7 percent and 0.8

  • percent of all of our ambulatory visits were over telemedicine.

  • This week, we're doing more than 75 percent.

  • We also created a program where we mounted an iPad on some specially

  • configured hardware to attach it to an I.V.

  • pole and turned it into an always on video intercom so that we could

  • reduce the need for providers to put on protective equipment, which is in

  • very short supply.

  • But continue to engage with patients in a way that's much more compelling

  • than just over the nursing call bell.

  • The University of Washington Hospital offers a number of telemedicine

  • services for specialties.

  • However, like most hospitals, not every service was equipped for

  • telemedicine. The high demand for care has left hospitals and practices to

  • retrain physicians on how to care for patients virtually.

  • In our healthcare system, we have an online training that everyone who is

  • credentialed in telehealth needs to complete, and that teaches us how,

  • logistically, how to do telehealth.

  • It gives us some tips about setting up a space.

  • So I'm lucky I'm in my basement at my house.

  • I have a separate room with a closed door.

  • It's quiet. When I am actually interacting with patients, I make sure I

  • wear my badge and that it's visible.

  • Telemedicine has adapted quickly during the time of coronavirus.

  • However, the practice hasn't been a perfect transition for all forms of

  • care, especially for doctors who are used to seeing patients every day.

  • It's been disorienting to see so few patients in person.

  • For a lot of doctors, this has been a learning experience, to put it

  • mildly, because we are so used to having our priority list and how we take

  • care of our patients dictated by who's on our schedule that day.

  • And now we just don't have the same mechanism.

  • Another thing that has become very important in this tragic crisis are

  • serious illness conversations with patients.

  • Talking with patients and their families about their choices and if they

  • have chronic medical conditions, talking about whether or not they would

  • want to be on a ventilator if their illness progressed rapidly due to

  • Covid and they could not breathe.

  • So, again, many of the things that we used to take for granted would

  • happen in person. We've now been forced to reinvent in this video only

  • environment. Telemedicine has helped maintain some business for the health

  • care industry, but volumes of visits are still down.

  • That could hurt the system financially over the long term.

  • One of the primary care clinics where I work, it looks like, our in-person

  • visits have decreased probably by 80 to 90 percent.

  • So they're at levels of 10 to 20 percent of what they previously were.

  • And then our telehealth visits, make up, bring us back to our prior

  • levels. So if we had before 100 visits a day, now we have maybe 20 in

  • person and 50 to 60 telehealth visits.

  • Something the federal government, I think, needs to catch up on is that the

  • way they have relaxed telemedicine regulations.

  • They still don't pay really nearly enough for practices to make up for the

  • lost volume that they're experiencing right now because patients are

  • really either staying home and visit volumes are plummeting across the

  • country for practices everywhere, and it's especially hitting small and

  • medium practices hard.

  • And doctors aren't necessarily making up that volume with telemedicine.

  • But also telemedicine visits only pay a third or even less of what a

  • normal in-person visit would pay.

  • So they're getting hit doubly hard.

  • Hospitals and other health care providers are slated to receive about 175

  • billion dollars to make up for the increased costs and lost revenue as

  • part of the Coronavirus Aid, Relief and Economic Security Act.

  • However, it might not be enough to save them.

  • This crisis has an enormous financial impact on hospitals.

  • We've canceled all of the elective cases that are what help support the

  • mission of the hospital, and we are now caring for the sickest of the sick

  • and those patients are staying in the hospital for a very long time.

  • And so without federal and state relief, this is an impossible burden for

  • hospitals to carry financially.

  • And we may be very much at risk of hospital bankruptcies because of the

  • extraordinary concentration of needing to spend more money, acquire more

  • supplies, care for the sickest of patients and at the same time, no longer

  • have the mainstay, the bread and butter of the procedures that largely

  • fund the operations of the hospitals.

  • Cleveland Clinic predicts within five years, half of the outpatient visits

  • in the U.S. will be virtual.

  • After this pandemic is over, telehealth will be here to stay and people w

  • ill want, they won't want to go back to only in-person visits.

  • I think people will want the option of telehealth visits as well.

  • Now, they can't replace our entire healthcare system and people still will

  • need to come in for their pap smears and exams.

  • But I think people will find a preference for this.

  • They won't have to take off a day from work or take three buses to travel

  • to the doctor's office or find childcare.

  • The system that we were in before was not particularly efficient.

  • There were just massive costs.

  • And you saw just, you know, that increase every single year.

  • It just it wasn't sustainable.

  • Telemedicine for a long time has been a way to bring costs down.