Opinion | Telemedicine has improved access to healthcare. Let it stay that way.


Telemedicine has emerged as one of several key innovations emerging from the coronavirus pandemic, making it easier for many people to access health care. But as the crisis phase of the pandemic ends, those gains could be reversed. Politicians should try to preserve them.

Before the pandemic, virtual medical visits were somewhat of a novelty. Telemedicine was conceived mainly as a service for patients living in remote areas who cannot travel to see a specialist doctor.

That changed with stay-at-home orders. In March 2020, the federal government granted providers broad — but temporary — flexibility to deliver health care services via two-way video and phone. Many doctor’s offices have quickly shifted in-person appointments to virtual ones.

The ability to continue virtual visits is tied to the federal government’s public health emergency for the pandemic. While there are bipartisan efforts to continue telehealth flexibility after the emergency ends, policy analysts have expressed concern that reimbursing providers the same amount for virtual and in-person visits could make health care costs harder to contain.

These are valid concerns, but we know that the sudden and unprecedented expansion of telemedicine during covid filled an unmet need, especially for underserved communities. That’s the main takeaway from a recent report by the Bipartisan Policy Center. (I am a BPC board member but was not involved in the research.)

The report’s authors analyzed federal Medicare data and found a dramatic uptake in telemedicine. In 2019, less than 1% of people who had Medicare for insurance participated in a telehealth visit. In 2020, as many as 44 percent did. There was some leveling off in 2021, with 28 percent seeking a telehealth visit in the first three quarters of that year.

The dominant specialty using telehealth is primary care. Almost all of these patients — 95 percent — sought virtual care from providers with whom they already had a relationship.

This finding is not surprising. My primary care colleagues have told me how much some patients appreciate the convenience of a quick phone check-in to manage chronic conditions like high blood pressure and diabetes. A virtual visit does not involve the hassle of taking half a day off work and asking relatives for a ride to the clinic.

The next most commonly searched specialty for telehealth was behavioral health. This also makes sense, since mental health counseling lends itself more naturally to virtual interactions than to conditions that require a physical examination.

The BPC study found that nearly half of all behavioral health screening visits in 2021 were made via telehealth. In contrast to primary care visits, 65 percent were new treatment relationships in which the patient was seeing that mental health professional for the first time.

Obviously, the use of telehealth has increased dramatically. And there’s an indication that the care provided by virtual appointments isn’t just extra care: Total visit volume—the combination of in-person and virtual appointments—was lower in 2020 and 2021 than in 2019, which suggests that virtual care replaced than added to personal care.

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The one notable exception is mental health, where many telebehavioral health seekers are new patients. This can probably be explained by the lack of access; about 150 million Americans live in areas with a shortage of mental health professionals, and telehealth has likely opened up mental health support to people who would otherwise not have received it.

Perhaps most surprising is who has benefited from these gains. Before the pandemic, those most likely to use digital health technologies were younger, whiter and wealthier. The BPC report found otherwise. Those most likely to use telehealth services in 2020 and 2021 are people with disabilities, minorities, and seniors with multiple underlying medical conditions.

Taken together, the research points to the expansion of telemedicine during covid either as a substitute for care that could be delivered more conveniently as a virtual visit or as providing services that would not otherwise be available.

Of course, telemedicine cannot and should not replace in-person care, as there are many diagnoses that require physical examinations, tests and procedures. Also, many patients prefer in-person visits now that the risk of covid is manageable. It is also unclear whether virtual providers alone can provide the level of high-quality care offered by traditional practices that offer both in-person and telehealth services. And it remains to be seen under what conditions telehealth is a cost-effective measure to reduce more expensive care such as emergency room visits and hospitalizations.

As researchers search for these answers, policymakers must keep in mind the large number of patients who have sought telehealth as a result of covid. It would be a shame if the gains made in increasing access were reversed as suddenly as they were implemented, especially given the vulnerable populations that have benefited from virtual care.

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