Prior to the onset of the COVID-19 pandemic, telehealth and virtual medical visits had already emerged as a healthcare option, starting in the early 2010s with the adoption of electronic health records (EHRs), but growth in usage was limited. In January 2020, less than 1% of primary care visits by Medicare patients were performed virtually. A major reason: the Center for Medicare and Medicaid Services (CMS) only reimbursed telehealth technology and virtual visits to designated rural areas and specific medical facilities. CMS also covered only certain types of medical practitioners and reimbursed virtual visits at lower rates than in-office ones.
With the pandemic’s onset and a declaration of a public health emergency in the United States, the situation changed as a result of efforts to limit public exposure to the rapidly spreading virus. The US federal government issued waivers that lowered barriers to the use of telehealth for Medicare patients, including removal of geographical restrictions, expanding the types of telehealth services that could be reimbursed, and instituting reimbursement parity between virtual and in-office care. State licensing requirements for many health care professionals were also eased to make it simpler for patients to access care virtually across state lines. By April 2020, around half of all Medicare visits had become virtual, and a report by the insurer United Health Group found that telehealth usage rose from 1.2 million visits in 2019 to over 34 million by the end of 2020.
A similar rise in telehealth has taken place in Europe, especially in the United Kingdom as well as Germany, France, and Norway, facilitated by policy changes at the member state and European Union levels. For example, Germany passed legislation allowing doctors to conduct about a third of health care visits by video calls outside of normal office hours and extended the ability to employ such practices to other medical professionals, such as midwives. The European Commission also adopted recommendations to permit the exchange of electronic health records across borders, and now at least 22 member states exchange EHRs, facilitating cross-border virtual care.
Today, even as pandemic restrictions wind down in many regions, the use of telehealth continues to expand. According to an Amwell survey, 76 percent of US patients expect to use telehealth services at the same level or more frequently than they did before the pandemic, and 92 percent of physicians said the same. Analysts at Fortune Business Insights project growth for the global telehealth market to US $185.6 billion by 2026, more than tripling in value from US $41.6 billion in 2019.
The rise of telehealth offers several advantages beyond reducing infection risk in seeking care. It has lowered barriers to care for patients with limited mobility or access to transportation infrastructure and has allowed health care practitioners to work independently with a more family-friendly schedule. Most importantly, it has increased healthcare efficiency overall, especially providing for more regular care for individuals with chronic conditions and improving continuity of care for those requiring day-to-day attention at a lower cost than hospitalization.
However, significant challenges to the continued growth of telehealth remain. Obtaining reimbursement for such services is still a major concern. The expansion of Medicare’s telehealth coverage was intended to expire 151 days after the end of the COVID-19 public health emergency, which was most recently renewed in April 2022. Policymakers are currently considering a variety of proposals to extend and potentially expand some or all of the existing flexibilities around telehealth services under Medicare. Without such changes, the waivers covering telehealth are due to expire, and beneficiaries in traditional Medicare programs could lose access to most services except for mental health needs.
The digital divide is another challenge to telehealth expansion and leads to inequity in patients’ ability to access telehealth. Studies have shown that older, black, or Hispanic patients are less likely to use telehealth than their white or Asian peers. Digital barriers include the reality that not every patient has access to a smartphone or computer, and the broadband services required for many applications are still lacking in some areas. Additionally, considerations of privacy and security regarding sensitive medical conditions and personal data still affect many patients’ willingness to access care electronically.
Finally, not every health care visit is amenable to telehealth methods. While patients and doctors alike have become comfortable with using telehealth for prescription renewals and regular chronic care checkups, such methods have been less acceptable for urgent care and new patient visits. In addition, methods for administering vaccinations and collecting biological samples remotely may eventually become more widely available, but today these activities still typically require in-office care.
Overall, we expect telehealth usage to continue to expand. However, the rate of growth is likely to be slower than it has been during the pandemic. “Early adopters” are already comfortable with this approach to care. To spur further uptake, reimbursement barriers must be addressed, more health care providers must gain digital expertise, and more health care sites need to adopt the necessary technology to facilitate telehealth approaches. In addition, a greater number of patients will need to obtain easier, more equitable access to digital technology and become more comfortable with virtual care.