During the height of the pandemic in 2020, telehealth use skyrocketed. Barriers to uptake that seemed insurmountable before 2020 melted away. The public health emergency prompted (temporary) decisions about issues such as reciprocal licensing, reimbursement, privacy/security, and acceptance of telehealth as an appropriate modality for the delivery of healthcare services.

Many organizations are advocating for permanent changes to CMS and private payer policies to support telehealth as an ongoing, critical part of healthcare services. The Biden Administration committed over $19M through HRSA to expand/improve telehealth in rural and other underserved communities.

So what will happen? Perhaps some early indicators can be gleaned from this relatively recent survey by the Center for Connected Medicine and KLAS. The survey was completed prior to the recent increase in cases related to the Delta variant (May and June 2021). Just under 100 responses were collected. The types of organizations represented included integrated delivery networks (30%), standalone specialty hospitals (29%), academic health systems (40%). Notably, ~1% were clinic/ambulatory entities.

There were six key findings (note that respondents could choose more than one answer):

1. Fewer telehealth appointments. Less than 20% of visits were virtual and those with a higher percentage expected volumes to decrease over time.
2. Chronic care a focus for the future. 50% or more of the respondents indicated intent for expansion of services in the following areas: Chronic care management, mental health/behavioral health, urgent care and primary care
3. More organizations measuring telehealth. The most frequent metric was visit volumes followed by patient satisfaction. Patient outcomes were only used 28% of the time.
4. Technology/broadband access an obstacle. Lack of patient access to technology and reimbursement were the two top obstacles followed by clinical workflows/integration into EHR and rural access to broadband.
5. Integration less of a challenge. However, about 25% of respondents indicated it was still a challenge.
6. Digital front door the leading access point. Two-thirds of the respondents indicated a portal/digital front door was the access point; 48% also indicated a standalone app was used.

What will the steady-state for telehealth be, and when will we get there? This was a small survey that did not reflect use by ambulatory care practices. However, as the pandemic seemed to calm down earlier this year, submitted claims for telehealth services decreased. The table below reflects changes to the volume of claim lines each month from the Fair Health tracker tool (see link below):

Months (2021)	% Change in Volume of Claim LInes
January – February	-15.71%
February – March	-5.08%
March – April	-12.50%
April – May	+2.04%
May – June	-10.00%

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Telehealth is here to stay. Technology for basic video calls is no longer a barrier (when bandwidth is available). Practice workflows adapted quickly during the pandemic which proved that inertia for that type of change can be overcome. The medical profession will continue to work through appropriateness guidelines. Quality metrics beyond volume and patient satisfaction will need to be embedded in the workflows and used for public reporting with no lower – or higher – expectations for virtual care than is expected of care provided in bricks and mortar locations. As remote physiologic monitoring technology, peripheral devices, and person-generated data become more prevalent and available (i.e., through wearables and other devices), use cases that include telehealth encounters will likely provide even more value to people and health care entities. Of course, this presumes that coverage and reimbursement policies will be made permanent and incentives through value-based payment models are sufficient.  

Related articles and websites:

Hospital Telehealth Visits Leveling Off at 10-20% of Appointments (Fierce Healthcare, Sept 2021)
Telehealth Took Off During the Pandemic. Now, Battles Over State Lines and Licensing Threaten Patients’ Options (TIME, August 2021)
Interstate Medical Licensure Compact
Taskforce on Telehealth Policy (NCQA)
Fair Health Monthly Telehealth Regional Tracker