If you were to ask any health system executive what the future of health care was in 2019, they would have said telemedicine. And in March of last year, with patients unable to access their physicians because of the quarantine, that shift to telemedicine happened in weeks, not years.
Telemedicine services through health care providers saw an immense peak in use resulting from the COVID-19 pandemic and, while many patients are returning to their physicians, area payers and providers have seen permanent changes in how patients expect care.
“When the pandemic hit, all health care providers were providing telehealth to some degree, but it was a small percentage,” said Jan Bergen, president and CEO of Penn Medicine Lancaster General Health during the Lancaster Chamber’s virtual State of the County event last month. “It gave us the ability to triage what patients needed to be treated virtually and who needed to be seen personally.”
Because of the pandemic, 2020’s telemedicine usage dwarfed 2019’s across hospital systems.
Last year, UPMC’s ambulatory telemedicine visits grew from about 250 a day in February 2020 to 15,000 by mid-April, said Dr. John Goldman, vice president of medical affairs at UPMC Pinnacle and infectious disease specialist.
“It’s since come down from that peak as more patients began to return to in-person clinical visits in our clean, safe hospitals, but today we still average about 6,500 telemedicine visits each day,” said Goldman.
Goldman added that improved telehealth services also means that patients have easier access to leading experts outside of the region, even if they are in an inpatient facility.
York-based WellSpan Health, which had already invested in telehealth products such as virtual urgent, primary and specialty care, and its MadelineRx online birth control solution, did more than 545,000 telehealth visits in 2020 as it expanded its services.
Dr. Roxanna Gapstur, president and CEO of WellSpan Health, said the patients ranged from newborns to the elderly, with 20% scheduled by patients over 60.
Penn State Health had also introduced telemedicine services prior to the pandemic but had focused on ALS care and urgent care through Penn State Health On Demand. In 2020, the Hershey-based health system saw its telehealth usage expand by 2,200%.
“We onboarded across our health system over 4,600 providers and staff,” said Chris LaCoe, vice president of virtual health at Penn State Health. “We enrolled around 60,000 patients and we really saw a massive uptick in our scheduled visits, our urgent care visits as well as some of the COVID screenings and testing that we had out there in the consumer space.”
Hospital systems in the region were already using video conferencing software between doctors and patients, and many health insurers already offered telehealth benefits prior to the pandemic. But reimbursements from third party payers, particularly Medicare and Medicaid, were much less than they would be in an in-person doctor’s visit if they were reimbursed at all.
The changes started when the Centers for Medicare & Medical Services, a federal agency that oversees Medicare and Medicaid programs across the country, introduced leniencies on HIPPA requirements on video software and broadened access to Medicare telehealth services. Third party payers followed suit by expanding their telehealth service coverage, offering advanced payments to independent health care providers and waiving fees for members using virtual care.
Pittsburgh-based Highmark Health saw its members use telehealth services 3,400% more than they did in 2019 with over 3.4 million telehealth services being accessed.
Both Highmark and Harrisburg-based Capital BlueCross waived deductibles, coinsurance and copayments, also known as cost shares, for outpatient virtual visits last year and into 2021
“Early on, we realized the financial toll the pandemic was taking on those we serve, so we acted quickly to waive member cost shares,” said Jerry Reimenschneider, senior public relations specialist at Capital BlueCross. “We also recognized the economic strain the pandemic was placing on providers, and acted to ease that strain. During the public health emergency, we’re paying providers the same rate for telehealth visits that we would for in-person visits.”
At Capital BlueCross, virtual visits through network providers grew from 22% of the insurer’s telehealth claims in 2019 to 81% last year. Capital BlueCross saw its largest surge between March and May, but the increase was largely sustained throughout 2020, Reimenschneider said.
Here to stay
The region’s health care experts expect the changes in telehealth to stay to some degree. Dr. David Webster, executive medical director at Highmark, said that telehealth as an option to access care is here to stay.
“Behavioral health will likely be continued to be delivered via telehealth as there is rarely a need for a physical exam among other advantages of telehealth,” Webster said. “There will likely be some chronic disease management and urgent care among other services that will continue to be delivered through telehealth based on patient preference and if their clinicians continue to offer telehealth services.”
The problems of such a quick switch to telehealth were evident early on in the process according to LaCoe, who said that Penn State Health did not have the robust infrastructure that it does now and between that and the stress quarantining had on internet service, the first month of telehealth services was not devoid of issues.
While there will still be work needed to better integrate telehealth among providers and patients, LaCoe said that he doesn’t see telehealth services dialing back after the pandemic.
“If traditional health systems aren’t able to provide this service, there will be other groups out there that are willing to,” he said.