A Telehealth Checkup

Checking in on telehealth who is here to stay.

Let’s do a check-up on telehealth.

The prognosis: based on recent data, the use of telehealth as a healthcare delivery system appears to be here to stay. Research also shows that Americans are continuing to avoid hospitals, and this tendency to stay away from brick-and-mortar healthcare is being reinforced by state-level legislation.  

Data demonstrates that the volume of virtual care visits has remained consistently above pre-pandemic levels, even as people return to in-person office visits. The most recent data has telehealth making up about 5 percent of all medical claims.  

As well, outpatient care more generally also remains more common than pre-pandemic levels. As an example, there were 20 percent more outpatient visits in March of this year, compared to March of 2019.

In contrast, inpatient, emergency department, and observation volumes have not returned to their pre-pandemic levels. For the month of March of this year, again, inpatient admissions were down over 10 percent compared with March of 2019, according to research from the analytics firm Strata Decision Technology.

For the first three months of this year, emergency room visits were down between 10 and 20 percent from their pre-pandemic levels.

Another analysis by Health Affairs predicts that this trend away from facilities would continue, concluding that healthcare spending for hospitals, nursing homes, and other medical facilities is expected to slow, while home healthcare costs are expected to rise.

While Americans developed the habit of using telehealth during the pandemic, states are working to make the habit permanent through legislation. About half the states have passed mandates that require parity in payment for telehealth.

In the meantime, Congress has stumbled at taking any permanent action at the national level. Medicare and Medicaid telehealth waivers will continue for about five months after the Public Health Emergency (PHE) ends, which, at this point, would be July, giving Congress until the end of the year to make the waivers permanent (or, you know, take some kind of action).

It’s worth noting that mental health is intricately related to telehealth. To that end, the Biden Administration and Congress are both working on initiatives and legislation on mental health, with bipartisan bills expected to be introduced in the last half of 2022.

The most recent data shows that mental health issues remain the top diagnosis for telehealth visits nationally, across all regions, and mental health accounted for 60 percent of all claims. Three of the top specialties that use telehealth are related to mental health; in fact, the top specialty providing telehealth services across most of the country…is the social worker.

So it was interesting to see that the successful telehealth company Cerebral announced last week that it will stop prescribing medications like Adderall and Ritalin for new patients, after employees questioned the company’s marketing approach. Cerebral joins CVS, Walmart, and others that have already stopped prescribing these medications through telehealth, in reaction to fears that the ease of access and availability of these drugs through telehealth may fuel the opioid crisis.

The Cerebral story shows that while America appears to moving irreversibly toward virtual health, there are still some issues in that approach to healthcare delivery that need to be worked out.