Since being diagnosed with cancer last year, Kent Manuel has been regularly seeing an oncologist near his home in Indianapolis. It was a difficult time. After spinal surgery for paralysis caused by cancer, he is gaining the use of his legs through physical therapy, but still uses a wheelchair.
Now, Manuel said, “I’m fighting the pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses cope with discomfort and pain and maintain quality of life.
So in November, Manuel, 72, a semi-retired accountant, started seeing palliative care physician Dr. Julia Friedman. “We talk about what works and what doesn’t work,” he said. “She listens to me. She’s very flexible.”
The first two drugs she prescribed to alleviate the pain had troubling side effects. But on the third try, “I think we hit on something that works,” he said. The pain has not gone away completely, but it has lessened.
Dr. Friedman, a senior medical director at TimeCare, a cancer treatment technology company, works hundreds of miles away in an office in Manhattan. She and Manuel used a video telehealth link, an option that largely didn’t exist in traditional Medicare before the coronavirus pandemic because of restrictive federal policies.
Medicare significantly expanded telehealth coverage in 2020, and the expansions are updated regularly. It could all have ended on December 31st.
Supporters of telemedicine, also known as telemedicine, endured tough days as Congress considered a continuing resolution to fund the government at the end of the year. The 1,500-page bill included a two-year extension to expand Medicare coverage of telemedicine.
Republicans had agreed to the resolution, but changed their mind after criticism from Elon Musk and Donald Trump. “This kills the bill,” said Kyle Zebree, senior vice president of public policy at the American Telemedicine Association.
Congress ultimately approved a narrower version: a three-month extension. Therefore, telemedicine will remain in place until at least March 31st.
Zebree estimates that 20 to 30 percent of medical encounters can occur virtually, and looks forward to further updates. Telemedicine is “so popular and so bipartisan in nature that I can’t imagine the Trump administration and Congress letting it expire,” he said.
Tricia Newman, director of the Medicare policy program at KFF, a nonprofit health policy research institute, agreed. “Telemedicine insurance appears to be here to stay as an option for Medicare patients,” she said in an email.
Its use has declined since the early days of the pandemic. At a time when patients feared keeping appointments and many health care providers closed their offices, Medicare began covering home video and audio visits for more types of providers and more conditions. I started.
Almost instantly, the use of telemedicine skyrocketed. In 2020, nearly half of Medicare beneficiaries had at least one such visit. By the end of last year, that percentage had fallen to about 13 percent.
This represents much higher usage than at the beginning of 2020, when approximately 7% of beneficiaries made virtual visits.
While telehealth works better for some services than others, “some patients have become dependent on it,” Dr. Newman said.
Get palliative care that is not available everywhere. For example, Indiana received a poor 2.5-star rating for palliative care capacity on the Center for Palliative Care Advancement’s state scorecard.
Telemedicine can help fill that gap. “By working closely with direct-seeing oncologists, we can provide appropriate care and access for patients with advanced cancer,” said Dr. Friedman.
Even if Manuel were able to quickly arrange an appointment with a local palliative care doctor, “I’m disabled, so traveling would be a hassle,” he says.
A short in-person visit can require an arduous two-hour process of getting into a car (driven by a caregiver), securing and unloading the wheelchair, entering the medical facility, waiting, and then reversing the process. there is.
Instead, “it’s so much fun to sit at home and hold the phone in front of my face and just talk,” he said.
Other patients described similar hybrid approaches. Jim Siegert, 74, a retired graphic designer who lives in Hopewell Junction, New York, sees his doctor four times a year to manage his diabetes, high blood pressure and high cholesterol.
“I’m a face-to-face person,” he explained. What’s more, blood tests are required, which “sometimes can’t be done over the internet.”
However, we will schedule a virtual visit, usually by phone, to discuss the results. “I’m glad to have that option,” he said.
Bruce Lerner estimates he will have 10 telemedicine visits in 2024. “It’s been a tough year,” said Lerner, 67, a Washington, D.C., lawyer. I had shingles. He had pneumonia. ”
Clinicians at One Medical, an Amazon-owned primary care organization, sometimes told him to come into their office or get a chest X-ray at a radiology clinic.
But about half the time, they listened, advised and prescribed virtually. “Not only will there be fewer unnecessary hospital visits, but there will probably be fewer emergency department visits,” Lerner said.
Helen Epstein, 77, of Lexington, Massachusetts, is tired of driving an hour in traffic to Massachusetts General Hospital. Her medical visits have overlapped over the past few years as Ms. Epstein, a writer, successfully treated uterine cancer, recovered from a stroke and battled atrial fibrillation.
So when you visit your primary care physician, they will be happy to schedule a video consultation. “The transition was very easy because she was my doctor for a long time,” Epstein said.
Her husband credits telemedicine for saving him from going to the emergency room after his friend’s dog bit him on the leg. Doctors reviewed the wound on video and determined that treatment at home was sufficient.
Many of the studies on telemedicine were conducted during the unusual time of the pandemic, and questions remain about its cost and effectiveness.
For example, an early study of about 200 elderly patients using telemedicine found that they were generally satisfied. But almost 40% say it’s worse than an in-person visit, and some find the technology frustrating.
While that may no longer be true in three years, “the main barrier is still technology,” Dr. Friedman said. Some providers are now sending patients a link and hiring staff to help them connect so they don’t have to remember a login and password.
Another early study using Medicare claims data reported that telemedicine slightly increased hospitalizations and clinician contacts, as well as slightly higher costs per patient. However, the authors caution that this may reflect increased hospital capacity in areas with higher use of telemedicine during the pandemic, and does not necessarily mean that the quality of care is lower. .
Meanwhile, another study found that health systems that increased the use of telemedicine saw an increase in patient visits and costs, but no change in hospitalizations and a decrease in emergency department use.
Recently, a clinical trial in patients with advanced lung cancer (mean age: 65 years) found that satisfaction and quality of life scores were significantly lower between patients who received palliative care via video visit and those who received palliative care in person. were found to be equivalent.
“The data is really murky because we were still reviewing the evidence from the public health emergency,” Dr. Friedman said. She added: “It would be beneficial to further study the results.”
Mr. Manuel is one of them. Telemedicine is “very efficient” and “expands the group of experts you can talk to,” he said.
“If available, I would choose telemedicine over an in-person visit.”
