- Telemedicine boomed in the US during the coronavirus pandemic.
- Now that states are reopening, many patients are opting back into in-person visits.
- Many hospitals and clinics are now grappling with a hybrid system that combines telemedicine and in-person visits.
- This article is part of a series called "Future of Healthcare," which explores how technology is driving innovation in the development of healthcare.
Doctors' offices and hospitals are emerging from the confines of telehealth-only visits as the pandemic-induced closures ease up around the US.
Telehealth's impact, however, is only just getting off the ground.
During the pandemic, doctors' offices and clinics rapidly adopted technology that allowed them to conduct non-emergency patient visits over the phone or video conference. They signed contracts with companies like Teladoc and Amwell, which provide access to such software and saw their businesses each roughly double throughout 2020 compared to 2019.
Those contracts are mostly still in place, even as some clinics and offices eagerly welcome patients back for in-person visits. With so much money at stake in a market projected to reach over $71 billion by 2027, hospital administrators that spoke to Insider were largely in favor of adopting a hybrid model where patients see doctors through a combination of virtual and in-person appointments.
Hybrid models are not without challenges. Hospitals are trying out different approaches to best serve what they need. That can create confusion for patients and doctors, who in the early days of the pandemic could FaceTime with a patient to help them through urgent tasks like administering insulin.
"I think that created a little bit of a bias in the understanding that care delivery in the hybrid model just requires you to have essentially a video line," Amwell CEO Roy Schoenberg told Insider. Instead, Schoenberg explained, a true hybrid model may incorporate smart glucometers that patch data through directly to the doctor's office from a patient's home in addition to regular video visits.
Insider spoke with hospital administrators, doctors, healthcare executives, and industry insiders to determine what challenges telemedicine still faces as the industry faces a plateau coming off of unprecedented growth during the pandemic.
Almost everyone who spoke with Insider agreed that telemedicine has a place within the American healthcare system moving forward, but three major roadblocks to its continued success emerged during interviews: where it fits in, how to get holdouts on board, and who is going to pay for it.
"We weren't any different than anyone else across the country in that we were immature in our telehealth journey prior to the pandemic hitting," Chris LaCoe, the vice president of virtual care for Amwell customer Penn State Health's 94 locations, told Insider. "There was a lot of innovation and entrepreneurial spirit, things were tried, visits were conducted, but through that experiential learning we found a number of challenges."
Doctors don't always agree on where telemedicine fits in
Doctors using telemedicine software were split on where the technology best fits into their practices going forward.
Some, like Orlando-based Nemours Children's Hospital operational vice president Carey Officer, see telemedicine as a replacement for traditional primary care checkups or other routine visits. Nemours uses Amwell's digital health software to conduct its virtual visits and scheduling.
Others like Dr. Todd Vento, a medical director for infectious disease at Utah-based Intermountain Healthcare, see its application depending mainly on the specialty.
For example, Vento explained, obstetricians might opt to see a patient in person monthly and conduct the rest of the visits virtually to cut down on the expectant mother's travel time.
Neurologists, on the other hand, might never log on and only opt to see patients in person.
Not all doctors want telemedicine
Hospital administrators face a hurdle in winning over doctors that saw telemedicine as just a crisis management tool instead of something that can be applied to future visits, Intermountain's Vento said.
Vento's hospital system covers most of the mountain west with 24 locations. Prior to the pandemic, many of the doctors in the system didn't want to learn the ins and outs of the new telemedicine software.
"I had providers, in January 2020, where we wanted to bring them up to speed with sub-specialty telemedicine and there was some resistance," Vento said. "Three months later, those same individuals were calling me up asking me, OK how can we do this. It's not ideal, but we'll take it."
Those doctors are more likely to revert back to in-person visits exclusively, Vento said. Getting them on board with any hybrid strategy could be difficult.
Reimbursement is still in limbo
Part of the hesitation, Dr. Ian Tong, the chief medical officer of virtual healthcare provider Doctor on Demand said, is the pending decision on who is going to pay for telemedicine visits going forward.
Insurance companies largely agreed to reimburse virtual visits on par with in-person ones during the pandemic, but those rules have not yet been made permanent.
"I think you'll find that people will sort back to where they were based on reimbursements," Tong said. "If you are a doctor in a health system that was fee-for-service, you are probably going back to the way you were doing things before, actually you probably can't wait to get back."
What insurance companies will and will not pay for has massive implications for how the healthcare industry operates, LaCoe explained. By agreeing to reimburse virtual visits on par with in-person ones, insurance companies were signaling that they thought the quality of care was also roughly on par enough to justify the cost.
If reimbursements change or vanish entirely, it could set back the telehealth industry that made significant progress during the pandemic to where it was before as a niche service.
"Before COVID, there was a fair bit of skepticism around telehealth in that, largely due to reimbursements, there was a belief that patients would rather be seen in person," LaCoe said. "The pandemic emergency taught us that that wasn't necessarily true."