Fifty years ago it was not unusual for a physician to deliver healthcare at a patient’s home. The physician would arrive clutching a black medical bag and perform the necessary examination without the patient even leaving the sick bed. Although convenient for the patient, the medical profession eventually abandoned this model. “It was not efficient from the time perspective and from the billing perspective,” says Junaid Razzak, MBBS, PhD, Department of Emergency Medicine at Johns Hopkins School of Medicine in Baltimore, MD. As physicians sought to monetize their time and the care they provided, that model made little sense. “It was more a business decision”, says Dr. Razzak.

Virtual and remote healthcare. A new paradigm

A new form of in-home care has emerged as physicians harness the speed and power of today’s Internet and offer telemedicine visits. This new model of healthcare delivery allows patients to virtually “see” a physician remotely, using almost any device that connects to the Internet from their home, office, or dorm room. In November, Dr. Razzak published a paper titled Telemedicine in the United States: An Introduction for Students and Residents. In it he wrote, “in the United States, 76 percent of hospitals connect with patients using some form of telemedicine…Kane and Gillis identified physicians practicing in radiology (39.5 percent), psychiatry (27.8 percent), and cardiology (24.1 percent) as the most frequent users of telemedicine.”

Although telemedicine has been around for decades, the COVID-19 pandemic thrust it into the healthcare spotlight, making it an attractive option for both physicians and patients who wanted to minimize their exposure to the COVID-19 virus during the pandemic. A study of trends at NYU Langone Health in New York City indicated an 80 percent decline in in-person visits and a whopping 683 percent increase in telemedicine visits between March 2 and April 14, 2020, according to Dr. Razzak’s paper. Healthcare is experiencing a “whole new paradigm” as the result of COVID-19, says Dr. Razzak, adding“I don’t think we can ever go back to normal patient care without telemedicine.” He states that as more statistics emerge, it’s becoming  apparent that patients value the time telemedicine saves them and the comfort it provides. 

Telemedicine offers comfort to Hispanics

Although Dr. Razzak is not aware of any statistics on whether or not telemedicine is warmly received within the Hispanic community, he has a hunch about its use. Minorities, especially those who do not speak English, are often intimidated by America’s healthcare system, he says. Some are forced to seek medical care from a physician who does not have access to an interpreter. “I would think that telemedicine would (eliminate) some of the intimidation, especially if technology is (easy to use). They would probably feel more comfortable using telemedicine,” says Dr. Razzak.  

Some fields lead the way

While attending physicians and their patients have enthusiastically embraced telemedicine during the pandemic, it should not be viewed as a silver bullet. It’s just another tool available to physicians that enables them to provide care. It’s not a replacement, “it’s an enhancement. Some patients may benefit from it, while others unfortunately will not,” says Dr. Razzak. “There are certain situations where the physical examination is very important and others where it is not as important,” says Dr. Razzak. If a patient, for example, is experiencing abdominal pain, it is crucial that the physician perform the examination by hand. 

There’s a host of medical specialties in which telemedicine is appropriate and others in which it’s not. Telepsychiatry, for example, lends itself to telemedicine because it’s verbal and visual in nature. Also dermatology, providing the patient’s device has a quality camera. Telemedicine is now even being used in the ICU. “(As long as you have) a provider on both ends (of the connection). You’d have a nurse or physician’s assistant or another physician supported by a teleconsultant,” says Dr. Razzak.   

Insurance, efficiency, and quality of care

Patients incur both direct and indirect costs when they seek medical care. The money a patient spends on office visits or on lab work qualify as direct costs while the money they spend on the gas they burn to get to a doctor’s office or a testing facility qualifies as an indirect cost. Telemedicine decreases a patient’s indirect costs. “What people eventually pay as a whole will go down,” says Dr. Razzak. 

What patients pay in direct costs, however, will largely depend on how the billing mechanism and the reimbursement system works. “If the reimbursement for telemedicine is comparable to reimbursement for in-person care then (costs) will not change,” says Dr. Razzak. If telemedicine becomes so convenient for patients that they seek care more often than what is expected, then costs might rise. Assuming COVID abates  and is no longer an issue in 2022, it will be interesting to see how healthcare costs respond, says Dr. Razzak. 

Currently physicians are charging the same price for an in-person office visit and a telemedicine visit. Telemedicine may be making physicians more efficient. “Physicians and nurses can rapidly see patients and the amount of time they spend in conversation is relatively short. I think overall the efficiency and the number of patients one could see is likely higher,” says Dr. Razzak. As an added bonus those physicians who offer telemedicine visits as an option have experienced a decline in patient no-show rates. 

The quality of care that telemedicine patients receive will depend largely on the patient for which the physician is providing care. For some patients the quality will remain the same but others may experience a spectrum, says Dr. Razzak. Some patients will just need to see a physician in person to receive quality care. 

Moving into the future of health

There’s a great deal of research and work going on to increase access to healthcare using technology. Dr. Razzak says telemedicine’s future hinges on the quality of data healthcare workers can collect from patients while they are at home, starting with very basic information like blood pressure, pulse rate, and temperature. Then physicians can start gathering more sophisticated evaluations like the change in the patient’s weight over time to changes in some other physical finding. “(There is probably technology out there) that can give us all this information, but commercialization is an issue. Most devices are ubiquitously available to people that would provide more informed care to the patients,” says Dr. Razzak. Even a device as common as an Apple watch can gather information that can assist physicians in providing care online.