Long gone are the days of physicians arriving at a patient’s bedside, medical bag and stethoscope in tow.
The idea of a house call is quaint, like something seen in an old movie. But during the COVID-19 pandemic, this idea has received a high-tech upgrade in the form of telehealth. The Centers for Medicare & Medicaid Services recently acted in the best interests of patients and healthcare providers by covering telehealth services through 2023. But unless Congress acts to expand coverage of telehealth services, healthcare providers will eventually lose the flexibility telehealth gives us to meet the needs of our patients.
Prior to the pandemic, my gastroenterology practice near Ann Arbor, Mich., had never used telehealth yet converted to it nearly exclusively at the height of the pandemic. Although the telehealth sessions were convenient and seemed effective, my colleagues and I wanted to study how patients and physicians were responding to this disruption in the way care is provided.
We worked with the Digestive Health Physicians Association to conduct an online survey of more than 500 gastroenterologists and nearly 1,500 patients from March to May 2020. Our results, published in Clinical Gastroenterology and Hepatology, demonstrated that more than 80 percent of patients and 90 percent of physicians surveyed were either satisfied or highly satisfied with telehealth. Greater than 80 percent of patients also indicated they were willing to participate in telehealth visits in the future.
In a follow-up study presented at the American College of Gastroenterology meeting in 2021, of nearly 3,000 patients surveyed who had experience with telehealth and in-person visits, 73 percent of respondents indicated they received a similar quality of care through telehealth as compared to in-person visits, and 61 percent stated that the interaction with their physician was similar. From a patient perspective, convenience and decreased cost are often cited as major reasons for their satisfaction with telehealth. Most patients (54%) were likely to continue using telehealth services after the pandemic mainly because of: shorter wait and travel times (75%), flexibility with personal schedule (56%) and ease of scheduling appointments (47%).
One of my earliest telehealth visits was with a patient in his 80s who spent nearly a month in the hospital after complex abdominal surgery. While at home with his daughter, this was the first visit to evaluate his progress after discharge from the hospital. We were able to address his concerns, assess his wounds using the video on his computer and formulate a plan for his continued improvement. At the end of the call, his daughter said, "Thank God we didn’t have to go to the office. That would have been a nightmare."
Her nightmare would have consisted of driving her frail father 45 minutes to our office, spending 15 minutes to park and waiting 30 minutes to be seen before finally speaking with me for 30 minutes. Following the appointment, my patient and his daughter would spend another 10 minutes checking out before the 45-minute drive home. Instead, they spent a few minutes logging on through a computer prior to the 30-minute visit from the comfort of their couch.
This ability to see my patients in their homes, cars and break rooms is an unexpected benefit of telehealth. Visiting with patients in their everyday environments has given me insight into how their lifestyles can affect their health. The most memorable includes a man sitting in his kitchen while smoking a cigarette and drinking a beer for breakfast. His main complaint was heartburn. During an in-person office visit, it might not have been so obvious his life habits might be contributing to his condition.
Congress is now contemplating the role telehealth will play in healthcare once the pandemic is over. Enabling patients to skip hours of logistical planning and instead interact with their providers from home would make accessing the healthcare system less expensive and logistically less challenging, especially among rural communities and people facing financial hardships. Our research suggests telehealth promotes the triple aim of improving healthcare by improving the care experience, reducing cost and improving patient and population health outcomes. Telehealth also increases access to care by decreasing travel time, limiting missed workdays and reducing the need to find alternative caregivers.
The adoption of telehealth is one of few silver linings of the pandemic. It will never replace in-person visits but should be preserved as a tool we can use when in-person visits are not the best option. For a small subset of people who lack the resources, access to technology or ability to do video visits, telephone-only visits are an appropriate option that should be preserved and reimbursed in some capacity. The future of U.S. healthcare must allow for a hybrid model so patients and providers can continue to benefit from this valuable innovation.
Naresh Gunaratnam MD, AGAF, is a practicing gastroenterologist with Huron Gastroenterology in Ann Arbor, Mich. He is chair of data analytics as a member of the Digestive Health Physicians Association executive committee.