Over the years, I have given my opinions on the need for changes in our health care system. We are the only “industry” that has not gone through a major disruption, though it is now starting to happen. One of those changes is telehealth, which took off with the COVID pandemic, and hopefully is here to stay. I believe it will continue to grow, especially in the field of allergy and asthma, as these conditions and others are among those that we can care for virtually.
Earlier this year, the AMA released their national telehealth survey report. ACAAI collaborated on the survey with them. You may have seen in a previous issue of Insider the results from our membership, showing that 97% of us had conducted live audiovisual interactive telehealth visits. In a column from Healio this spring, there was an excellent summary of these findings in our field, with a great editorial by Allen Meadows, MD, FACAAI, who discussed the need for the federal government to relax rules and regulations on telehealth and continue to pay for these services on par with in-office visits.
I think the AMA survey gives clear direction on how telehealth is reshaping medical practice in the U.S. 85% of physician respondents indicate they currently use telehealth. Those who report a decrease in use after COVID peaked indicate that they are now doing a mix of in-person and virtual care. The vast majority of telehealth visits are with established patients, but I think this may change in the future, with more direct-to-consumer telehealth services developing in the U.S.
Interestingly, physicians are doing 64% of their virtual visits at home. Will telehealth improve work-life balance to allow more time at home and reduce the need to commute to one or more offices on a regular basis? If true, this could help alleviate the burnout epidemic in physicians and help with the growing shortage of physicians in the U.S., particularly in rural areas.
I was surprised at the answer to the survey question “What specific use cases within your specialty do you find most appropriate for telehealth?” Two conditions came up in our field – asthma and eczema. I would have expected allergic rhinitis to be on the list.
I think one of the keys to the growth of telehealth was better access to care. I know one of the biggest gripes of patients is how long they have to wait for an appointment. More than 80% of the physicians surveyed agreed or strongly agreed that patients have better access to care since they began telehealth. Along with that, physicians are saying that their patients are more satisfied since using telehealth. Physicians’ professional satisfaction has also increased. Looks like a win-win situation to me.
With all the great reasons for continuing and increasing telehealth visits, what are the barriers that may stifle its growth? One is the “digital divide” that impedes many of our patients’ ability to participate in virtual visits. The recent bill to increase access to broadband internet in the rural areas should help with some of these issues. Unfortunately, many patients may not be able to easily use the technology needed for audio-visual visits, so we still need to have coverage for telephone-only telehealth visits.
What I believe is the biggest barrier with telehealth is payment and reimbursement. If we lose payment parity of telehealth with in-office visits by the federal government and/or the insurance companies, telehealth visits may decrease dramatically or even come to a halt. We know that telehealth is being used to replace office visits and not adding more “visits” with us. We need the payers to understand that it will not cost more money, but in fact may reduce costs by improving “show” rates for visits, especially in patients with chronic conditions. That is why the College and the AMA, along with other medical societies, are pushing for audio-only visits, continued coverage, and equal reimbursement when the COVID waivers end. Telehealth is good for our patients and good for us.