Telehealth’s Post-Virus Power in Doubt as Virtual Visits Decline

Virtual doctor’s visits in August were half of what they were during their April peak, a sign the pandemic might not be the turning point for virtual health without sweeping changes.

Telehealth visits are still more common now than they were pre-pandemic. The number of weekly virtual visits was 7% higher the first week of August than they were the first week of March when the pandemic began, new research from The Commonwealth Fund shows. But that’s half of the virtual visit peak in April when weekly telehealth visits were roughly 14% higher than they were pre-pandemic.

A Thursday Deloitte survey also showed virtual health care rose from 19% of visits early in the year to 28% in April. Despite the rise, “fewer consumers were happy with their clinician” compared to 2018. Wait times appear to be a bigger issue this year than previously, the survey showed.

The separate reports offer a more nuanced look at how the U.S. is adapting to virtual health care and whether it has staying power after the pandemic ends. Last week the Trump administration permanently expanded the type of services available virtually, but that’s not enough, doctors and researchers said. To make it stick, doctors need assurance the initial investment in training and technology will be worth it, and consumers need assurance the visits will be high quality.

“Video isn’t easy,” Ateev Mehrotra, a doctor and Harvard researcher, told lawmakers last week during a rural telehealth roundtable. He is one of the authors on The Commonwealth Fund’s telehealth research.

“In the midst of the pandemic, video visits reverted to phone calls” because they’re easier for doctors, he said. Now that in-person visits are being allowed again, people don’t want a virtual visit as much.

“Providers need to know now what telehealth policy will look like post-pandemic” if they’re going to invest in doing it well, he said.

‘Antithesis’ Of Telehealth

The Trump administration loosened some rules around telehealth in March, letting patients take appointments by phone from home. A larger array of services will be available to patients after the public emergency ends thanks to permanent changes the administration made last week. Those don’t help the biggest barriers around virtual health like location rules, which have to be changed by Congress.

Patients typically can’t be at home or in their car when they’re having a virtual doctor visit, “and that’s the antithesis of when we think about telehealth services and the ability to get care when you need it,” Jacob Harper, a Morgan Lewis attorney based in Washington D.C., said. “It leads to situations that no one uses it because you already have to be at the doctor’s office,” he said.

There’s bipartisan support for axing geographic restraints on teleheatlh. A group of 30 bipartisan senators wrote to Congressional leaders in June in support of the CONNECT for Health Care Act (S. 2741), which would make virtual visits from home easier.

“When 30 senators co-sponsor a bill, it has some legs,” Harper said, especially when it aligns with the White House’s agenda. One barrier, though, is the cost. The Congressional Budget Office, which tallies how much legislation will cost or save, can’t analyze “the benefit or opportunity cost of certain things,” Harper said. That means it can’t take into account money saved from ER visits or hospitalizations avoided by preemptive virtual care.

“So it looks like a net increase in cost even though when we read between the lines it’s more nuanced than that,” he said.

‘Webside’ vs ‘Bedside’ Manner

From a consumer standpoint, virtual visits’ persistence will ultimately depend on user experience, said Leslie Korenda, a research manager at the Deloitte Center for Health Solutions and one of the authors of the telehealth survey. Before Covid-19, providers weren’t communicative enough about their telehealth services. Now they’re sending out emails and explaining to patients how to sign up for virtual visits.

Training to use the technology isn’t enough. Doctors also need to get a better grasp on how to show empathy through a screen. Perfecting their “webside manner” to match their in-person “bedside manner” is important, Korenda said.

The Deloitte survey showed people using telehealth are getting the information they need and the prescriptions they need, but they’re “still not feeling increasing rates of comfort or that they’re being listened to,” Korenda said. “That connection you feel with someone is still important,” she said. “It’s still a top concern for consumers, even with virtual visits.”