This many months into COVID-19 and I think we all have to look at what all the changes are going to mean for healthcare. I know that so many telehealth advocates are saying the genie is out of the bottle and related phrases, but I think there’s still a lot more to be said about the future of telehealth.
While I still have Stacy Hurt’s recent comments on this webinar ringing in my ears about how she’s not going to allow her doctors to go back to in-person visits, I wonder if patients can really exert that much influence over doctors. I hope they can, but if the doctors aren’t getting paid as much for telehealth as an in-person visit, it’s going to be a real battle for patients to keep demanding telehealth.
The reality I see is that COVID-19 created a false market for telehealth. I call it a false market because the number of telehealth visits we saw during COVID-19 weren’t driven by natural forces that are going to persist forever. I know about these false markets because we saw the same thing happen with EHR software. $36 Billion in EHR stimulus money created a false market where people went crazy chasing government money. EHR adoption was high, but we knew it wouldn’t last forever. The same is true today with telehealth video visits.
False markets are not necessarily a bad thing unless you drink the Kool-Aid that the false market is going to last forever. I’m not sure even the most ardent telehealth supporters thinks that 50-60% of visits should all be telehealth visits like was happening at the height of stay at home orders under COVID. In many of those cases, both patient and doctor would have rather been in the office, but COVID prevented that. However, the false telehealth market did expose telehealth to both doctors and patients that may have previously been skeptical. Now, we’re going to see how many have become converts and how many revert back to old habits. Never underestimate the gravitational pull of the status quo.
We’ve already seen the pullback of telehealth happening as we shared before. The real question is how far are we going to pull back. In other words, what does a rational telehealth market look like. It’s clearly far above the 0.1% telehealth adoption (or something close to that number) we had prior to COVID-19, but it’s also likely much less than the 50-60% adoption we saw at the height.
My gut tells me that the real telehealth market is closer to 10-15% of office visits and the best health systems will push that to 20%.
Of course, there’s one big determining factor in all of this and that’s reimbursement. If telehealth reimbursement doesn’t figure out the payments so that the same service provided through telehealth is reimbursed at the same rate as in-person, then we could see an even bigger fall off of telehealth. If reimbursement is wrong, I could see us falling into the low single digit office visits. That would be sad to see and would no doubt anger many patients who grew fond of telehealth during COVID.
Yes, I’m sure we’ll see some direct to consumer (DTC) telehealth options that are successful as well. We already are seeing those and they work in affluent areas where patients can pay for those types of services. The problem I see with those is that they don’t scale to the entire health system.
I’m also fond of a lot of what’s happening in the chronic care management (CCM) and remote patient monitoring (RPM) space. Although, I see those as a remake of the health system as we know it with telehealth as one piece of their solution. So, I classify them separate from the live video telehealth visit market. I do think they’ll grow larger over time, but those are going to be a slow burn evolution and not a dramatic replacement of what healthcare does today.
What do you think the real telehealth market will look like? Where will we land when it comes to telehealth video visits? Do you see other drivers that will determine the future of telehealth beyond reimbursement? Let us know in the comments or on Twitter with @hcittoday.