In telemedicine’s time to shine, why are doctors abandoning it? – Health News Today

Telemedicine — the delivery of care by a clinician in one location to a patient in another — is seen as a vital component of the nation’s response to the Covid-19 pandemic. The Centers for Disease Control and Prevention and the World Health Organization have urged physicians and other health care providers to use telemedicine, and both the federal government and private health plans have implemented numerous temporary regulatory and payment changes to facilitate its use.

Physicians initially responded to these changes. Based on a sample of more than 50,000 clinicians who are clients of Phreesia, a health care technology company where two of us (D.L. and H.H.) work, we saw a sudden and dramatic rise in telemedicine (see the chart below). From almost no telemedicine visits before the pandemic struck in the U.S., by early April almost 14% of the usual weekly number of pre-pandemic visits were being conducted via telemedicine. The assumption among many was that, after witnessing the benefits of telemedicine, physicians and patients would embrace it and growth would continue.

Patrick Skerrett / STAT
Source: Phreesia, Inc. Provider organizations were broken into four groups (1-5, 6-20, 21-100, 100+) based on the number of clinicians in the organization. Percentages represent the number of telemedicine visits in a given week divided by the number of all visits (telemedicine and in-person) in the baseline week beginning March 1.

That hasn’t happened. In fact, the use of telemedicine is now steadily declining and during the week of June 14 was used for only 8% of the usual pre-pandemic number of visits.

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What happened? Did telemedicine fail to deliver? Or is something else going on?

Implementing telemedicine isn’t easy. To do it well, a physician practice must buy appropriate technology and train staff and patients to use it. It takes time to help an 80-year-old unfamiliar with technology do a video visit. New workflows must be introduced. If a patient needs a laboratory test, for example, where do you send them? Clinical schedules need to be changed. Documentation protocols must be updated. And on and on.

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This type of implementation takes both resources and expertise. Not surprisingly, bigger organizations with dedicated information technology, procurement, and implementation teams were able to do it more successfully. Bigger organizations (100-plus clinicians) were able to shift almost 16% of their pre-pandemic visit volume to telemedicine (see chart above). Smaller provider organizations (five or fewer clinicians) were using it at approximately half that rate.

In the midst of a lockdown and stay-at-home orders, physicians did what they could and switched to telemedicine visits as their only option. Because of technology problems with video visits, many reverted to phone calls. But as we are getting into a new normal and communities are reopening, making in-person visits an…

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