By Karen Lynch | American Express Credit Intel Freelance Contributor
6 Min Read | October 28, 2020 in Money
After a slow start, telemedicine is experiencing rapid growth after encouragement from the government and health care industry.
Patients have an array of new telemedicine options that could cut their medical bills and save them time.
Still, telemedicine pricing and insurance reimbursement policies are in flux, so if you’re planning to use it you may want to check on your doctor’s terms and conditions.
Doctors have begun making house calls again – virtually, that is – as telemedicine has caught on in 2020. Physicians have replaced many office visits with remote consultations using smartphones, videoconferencing, messaging, remote patient monitors, online health portals, and more.
Telemedicine is not new, but it never quite took off until now. Policymakers and the health care industry hit the accelerator this year, promoting telemedicine to overcome limitations on in-person doctor visits in early 2020. Now, many of the changes they made in regulations and standard operating procedures are expected to last, continuing to drive telemedicine’s growth in the future.
If there’s no turning back, what might the new doctor-patient relationship look like? Answers to this question touch on everything from quality of care to pricing and payments.
The Kaiser Family Foundation defines telemedicine as “the remote provision of health care services using technology to exchange information for the diagnosis, treatment, and prevention of disease.”1 The term telehealth is often used interchangeably with telemedicine, though telehealth may also include everything from health-related education to electronic record-keeping.
Telemedicine is available from a growing array of physicians, hospital groups, drugstores, online telehealth companies, employer-sponsored health plans, and others. Nearly half of physicians (48%) are now treating patients via telemedicine, up from 18% in 2018, according to a physician search firm.2
At the same time, people are showing a growing interest in telemedicine for prescription renewals, chronic disease management, surgery follow-up, mental health, skin conditions, basic primary care (say, for a minor injury or upset stomach), and more. Telemedicine visits increased 300-fold from March–April 2019 to March–April 2020.3 Prior to that, a Harris poll found that 66% of patients were willing to use telemedicine, but only 8% had tried it4 – a gap attributed to the combination of patient, medical provider, and insurer drawbacks described below.
Basic telemedicine sessions might involve typing questions and responses to your doctor in a messaging platform, talking with a physician by phone, or interacting face-to-face using video chat. Some platforms allow doctors on a call to simultaneously review a patient’s medical record, type in notes, exchange pictures and video in real time, and share a record of the session.5 Patients might go to the drugstore to buy a blood pressure cuff, oxygen monitor, or other device helpful to the call. “As telemedicine increases in popularity, more options are becoming available for you to connect with a doctor online,” one personal finance expert explained.6
Cutting-edge innovations in telemedicine are also developing to let virtual assistants help patients stick to their treatment plans, for example, or to use artificial intelligence (AI) to continuously record, analyze, and report changes in vital signs. “Emerging technologies like AI and digital health devices have the potential to expand access to health care,” according to a major think tank.7
Many see saving time and money as the primary benefits of telemedicine, with the question of quality of care still up in the air.
Saving time: How much time can you save? Consider that it typically takes two hours, including in your car and the waiting room, to see a doctor for 20 minutes.8 Telemedicine patients said their entire experience took an average of 44 minutes, in a poll by the J.D. Power consumer intelligence company.9 What’s more, getting an office appointment with a primary care provider can take about 21 days.10 Some telemedicine sessions are offered immediately, 24/7.11
Saving money: While medical costs vary widely, comparisons show that an adult office visit costs an average of $130–180, according to one insurer.12 A telehealth visit can cost $50–80, on average.13
Quality of care: Reviews regarding the quality of telemedicine are mixed: In another J.D. Power poll, almost half of respondents believed the quality of care was lower than they received in a doctor's office, while 45% believed it to be the same, and only 6% perceived the quality as higher.14 One patient’s guide underscored the limitations when a doctor cannot touch a patient’s body or listen to their heart or lungs, but added that a virtual visit might set up an in-office visit, if needed.15 In an academic study, 74% of patients using telemedicine reported that their health concerns were resolved on the call.16
A sign of the times in telemedicine was the 2020 launch of a telehealth marketplace, including the pricing of 100 services, searchable by type of treatment.17 More generally speaking, though, the appeal of telemedicine’s lower cost has been tempered by uncertainties about related matters, such as insurance reimbursement.18
On telemedicine calls, patients may be asked to enter a credit card or other payment method for a first visit when signing up for an appointment, with the fee collected upfront and later reimbursed by insurance. Upfront payment methods might also be used to handle insurance co-pays, deductibles, and coinsurance.
Whether you have private health insurance, Medicare, or Medicaid, it’s recommended to check on telemedicine coverage, which varies and is in flux, as described below.
While most experts expect the telemedicine field to keep growing, barriers remain. “Coverage and reimbursement of telemedicine is still far from uniform among [health insurance] payers, and most changes to telehealth policy are temporary,” said the Kaiser Foundation.
Some advocates are urging permanent adoption of the kinds of insurance coverage and other policies implemented during 2020. Those include allowing insurance coverage of telehealth, waiving some privacy restrictions on video chats and messaging, and allowing cross-state medical licensing. “We are definitely going to be pushing for some of these new policy flexibilities to remain in place,” said an official with the American Medical Association, adding that, “There are going to be changes in the practice of medicine going forward based on all this use of telehealth. We are quite certain of that.”19
By the numbers, U.S. telehealth spending is estimated to grow seven-fold by 2025, resulting in a five-year compound annual growth rate of 38%.20
Telemedicine is ushering in far-reaching change in the way patients are treated. It can be more timely and less expensive than in-office visits, while still delivering quality of care. Yet, fundamental pricing, insurance, and other matters are in flux, and likely to remain so for a while.
1 “Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19 Emergency and Beyond,” Kaiser Family Foundation
2 “Survey: Physician Practice Patterns Changing as a Result of COVID-19,” Merritt Hawkins
3 “Expansion of Telehealth During COVID-19 Pandemic,” Epic Health Research Network
4 “Telehealth Index: 2019 Consumer Survey,” Amwell
6 “5 Things to Know About Telemedicine,” Clark
7 “Removing Regulatory Barriers to Telehealth Before and After COVID-19,” Brookings Institution
8 “Telehealth Can Reduce Costs and Help Improve Access to Care,” Kaiser Permanente
10 “Telehealth Index: 2019 Consumer Survey,” Amwell
11 “The Best Telemedicine Apps of 2020,” Healthline
12 “Typical Costs for Common Medical Service,” Blue Cross and Blue Shield of Massachusetts
13 “What You Need to Know About Telehealth During the Coronavirus Crisis,” Wall Street Journal
15 “A Patient’s Guide to Telemedicine,” Health Information and Management Systems Society
16 “On-Demand Synchronous Audio Video Telemedicine Visits are Cost Effective,” American Journal of Emergency Medicine
17 “Introducing the GoodRx Telehealth Marketplace,” GoodRx
18 “Telehealth Index: 2019 Consumer Survey,” Amwell
19 “COVID-19 Makes Telemedicine Mainstream. Will It Stay That Way?,” American Medical Association
20 “Telehealth to Experience Massive Growth with COVID-19 Pandemic,” Frost & Sullivan