The Tipping Point for Telehealth

By ALEXA B. KIMBALL MD, MPH

The tipping point for telehealth just happened. Many ways of doing business will change forever after the experience of the COVID-19 pandemic, and health care, too, will never be the same. 

Between the release from some HIPAA requirements announced by President Trump this month, shifts in payor policies, and mandated insurance coverage of telehealth visits, innovation and adoption are taking off like wildfire. As patients and outpatient-based physicians hunker down at home, they are rapidly experimenting, and improving the way care is being delivered remotely. 

Our institution, which had no prior program, faced with an imminent shut down of elective activity, developed an enterprise-wide telehealth program in days, rendering hundreds of visits as soon as we launched it. This activity is being replicated all around the country. 

Turns out, as the physicians and patients have known all along, the impediments to being able to provide telehealth were not in the technology, which has been adequate for years. It was in fact the regulatory framework and the lack of reasonable—and in many cases, any—reimbursement. With those barriers lifted, the demand that so many patients and providers had for these services is now being met. 

Why did payors resist for so long, when it seemed so obvious that telehealth was what people wanted? Moreover, it should be less costly than in-person care because it minimizes staff and building expenses. 

The real problem was that opening up telehealth was too scary for payors. Data showed that availability increased utilization and they feared activities like phone calls, which weren’t reimbursed before, suddenly had costs. That defensive posture stalled innovation. Even as payors grudgingly started to pay for incremental activity, closed systems like Kaiser who are responsible for both care and cost moved rapidly to use telehealth in efficient ways and demonstrated the utility.

Of course, not everything is suitable for virtual care. But lots of encounters are, and it’s likely that physicians and patients won’t want to go back to the way it was before COVID-19 necessitated the advent of widespread telehealth coverage.  So looking into the future on the other side of this pandemic, it will be our duty as front-line providers in the health care system to advocate for these positive developments to endure. 

But for now, as we take care of people in all sorts of new ways, it’s worth noting that something important has happened.

Dr. Kimball is the President of Physician Performance LLC (PLLC), the CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and a Professor of Dermatology at Harvard Medical School.

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