The pandemic opened the floodgates to telehealth. Now, many patients and doctors are curbing their enthusiasm for virtual care.
Four out of five primary-care doctors who had video visits with patients during the pandemic would prefer to provide just a small portion of care or no care at all via telemedicine in the future, according to a survey designed and analyzed by researchers at Harvard T.H. Chan School of Public Health and published last month in Health Affairs, a peer-reviewed journal. And 60% of the doctors surveyed said the quality of care delivered via video was generally inferior to in-person care.
Patients are only slightly more keen on telemedicine, the study found, with nearly two-thirds saying they’d prefer to have all or most visits in person in the future.
The findings coincide with data showing a dropoff in telehealth usage. Data released this week by FAIR Health, a nonprofit focused on healthcare transparency, shows nationwide telehealth utilization dropped 6.8% in February, following three consecutive months of growth. The data represent patients with private insurance, excluding original Medicare and Medicaid.
The doctor and patient survey results suggest that telemedicine may play a key role in future health emergencies but will likely play a smaller role in primary care, at least in the near term, according to the Health Affairs study. Although policies were once thought to be the barrier keeping telehealth in check, pandemic-era rule waivers knocking down those barriers have largely remained in effect even as many patients and doctors have shifted back toward in-person care, said Gillian SteelFisher, principal research scientist at Harvard T.H. Chan School of Public Health and lead author of the study. The patient and doctor perspectives help shed light on that shift, she said. Telemedicine is “still an incredibly useful tool,” she said, and essential in preparing for pandemics to come, but more work is needed to understand how to make the technology even more useful.
The research adds a new wrinkle to the regulatory muddle that telehealth providers face as the COVID-19 public-health emergency officially comes to an end next week. Some of the federal government rule changes that were intended to temporarily pave the way for telehealth during the pandemic have been extended to the end of 2024 or made permanent. Others are in limbo. The U.S. Drug Enforcement Administration, for example, recently said it needed more time to finalize a proposal that would have largely reinstated prepandemic requirements that doctors see patients in person before prescribing certain controlled medications via telemedicine. The DEA was bombarded with more than 35,000 public comments on the proposal, with many critics raising concerns about the impact on patients with mental-health and substance-use issues.
Consumer protections are also at stake, some experts say, for some people using large employers’ telehealth benefits. During the pandemic, employers could offer standalone telehealth benefits to employees who were not eligible for the employer’s health plan, such as part-time or seasonal workers. Now, employer groups and some lawmakers want to make the change permanent and treat the standalone telehealth benefits as exempt from most federal regulation that typically applies to employer health plans. That could come with “substantial risks for workers,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms. “It would be exempt from important patient protections,” she said, such as rules meant to protect people with pre-existing conditions.
States, meanwhile, generally “seemed to turn on the spigot full bore” to accommodate telehealth during the pandemic but have stepped back a little as they adopt more permanent measures, Volk said. Some states that allowed audio-only visits during the pandemic, for example, are reining in that flexibility, she said.
Roughly 20 states now have laws requiring that healthcare providers be reimbursed the same amount for telehealth as for in-person visits, said Jared Augenstein, managing director at Manatt Health. But many states are also shifting back toward pre-COVID restrictions, he said, by limiting healthcare providers’ ability to provide virtual care across state lines.
Investors’ pandemic love for digital health startups has shown signs of cooling. Startups in this niche raised $15.3 billion in 2022, down 48% from 2021, according to Rock Health, a venture investor and advisory firm. With $3.4 billion raised in the first quarter, 2023 is on track for the lowest level of annual funding since 2019, according to Rock Health.
The Global X Telemedicine and Digital Health
EDOC,
exchange-traded fund is essentially unchanged in the year to date, while the S&P 500
SPX,
is up 6.1%.
Privacy concerns have become a stumbling block for some companies in the industry. The Federal Trade Commission in March issued a proposed order banning the online counseling service BetterHelp, a unit of Teladoc Health Inc.
TDOC,
from sharing consumers’ health data for advertising and requiring the company to pay consumers $7.8 million to settle charges that it shared sensitive consumer data with third parties such as Meta Platforms Inc.’s
META,
Facebook and Snap Inc.’s
SNAP,
Snapchat. In a statement, BetterHelp said: “[O]ur technology, policies, and procedures are designed to protect and secure our members’ information so it is not used or shared without their approval and consent.” The company said in the statement that it had never shared private information such as members’ names or clinical data with advertisers, publishers or social-media platforms and had never received any payment from third parties for member information. Teladoc did not respond to a request for comment.
Even if it’s ultimately just a small but meaningful slice of care that’s delivered virtually, that would still be a big improvement over the prepandemic situation, the Health Affairs study said, because it would help doctors easily expand to telemedicine if necessary during a future infectious-disease outbreak. Having the right telemedicine foundation in place is critical, SteelFisher said, so we can “flip the switch when needed.”
Although many doctors in the Health Affairs study saw telemedicine care as lower in quality than in-person care, that perspective wasn’t necessarily the best predictor of their preferences for virtual versus in-person care, SteelFisher said. That suggests there’s a human factor at work, she said. “Do physicians really want to be on Zoom?” she asks. “Is that what they went to med school for? The feeling of being a good provider is really important,” she said.
The challenge now, she added, is to support the development of telemedicine where it’s clinically relevant “and still allow physicians to practice the way they want to practice.”
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