Physician viewpoint: COVID-19 let virtual medicine out of the bottle & now it's time to tame it

Virtual care was a vital part of medical care during the pandemic, but as the pandemic curbs, so should telehealth, Elisabeth Rosenthal, MD, former emergency room physician and editor-in-chief of Kaiser Health News, wrote in an April 29 op-ed published in The New York Times.

Deploying telehealth too quickly risks poorer care, inequities and inflated healthcare charges in a system already infamous for big bills, Dr. Rosenthal said.

Seven things to know:

1. Virtual care is great for simple visits, but the way telemedicine startups are promoting it benefits providers' and investors' pockets, rather than focusing on more convenient high-quality and cost-effective care for patients, Dr. Rosenthal said.
   
   
2. In the first six months of 2020, telehealth companies raised record amounts of funding, with five startups each raising more than $100 million.
   
   
3. Since telemedicine is reimbursed closely to in-office visits, many practices are offering or encouraging patients to visit virtually. Doing so becomes a revenue multiplier, adding to patient expenses, she said.
   
   
4. In one example, a patient noticed a rash and was directed to a practice's telemedicine portal and billed $235 for a five-minute video appointment. Since rashes are often hard to evaluate in a video call, he was told he needed to see a doctor in person for the diagnosis and was charged $460 more for that visit.
   
   
5. Dr. Rosenthal said she worries that post-pandemic reimbursement practices have taken traditionally free screening calls and rebranded them as billed visits, with no additional value.
   
   
6. Telemedicine can create new roadblocks to equity, Dr. Rosenthal predicted. Even though it has the potential to improve access for people in rural and underserved areas, video visits require high-speed internet, which is less common among those same groups.
   
   
7. There is also the chance that lower-income patients will receive more care through telemedicine clinics, since they are cheaper and require less staff, compared to patients with high income levels, Dr. Rosenthal said.

"There is much to be resolved and fast, with scientific evidence and doctors, hopefully, driving the decisions," Dr. Rosenthal said. "If we allow the market to make the choice, we risk preserving those telemedicine services that make money for business and providers — or save it for insurers — and lose those that most benefit patients."