COVID-19 Is Driving Telehealth’s Growth. What Happens After The Pandemic?

Dr. Alfred Torrence
Dr. Alfred Torrence from Howard Brown Health said that before the pandemic, the LGBTQ health center had only experimented with telehealth. Since March, it’s become an extremely popular option among his patients. Katherine Nagasawa / WBEZ
Dr. Alfred Torrence
Dr. Alfred Torrence from Howard Brown Health said that before the pandemic, the LGBTQ health center had only experimented with telehealth. Since March, it’s become an extremely popular option among his patients. Katherine Nagasawa / WBEZ

COVID-19 Is Driving Telehealth’s Growth. What Happens After The Pandemic?

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Eight-year-old Zain Jackson has cerebral palsy and has undergone physical therapy for nearly all her life.

When the coronavirus pandemic hit, her mother Jozmin worried that Zain could lose those in-person services, as well as her therapy progress. But Jozmin Jackson said telehealth sessions that have allowed them to virtually connect with Zain’s physical therapist from La Rabida Children’s Hospital in Chicago have kept that from happening.

“My daughter took her first steps — just based off of Jenny observing her through the virtual chat and giving me suggestions,” she said. “I was glad that I took that extra step to see if there was anything else out there available for my baby since we were at home.”

Via a webcam, therapist Jenny guides the pair through sessions at their home near suburban South Holland. She shows Jozmin how to position her daughter’s body and what household objects they can use to practice coordination, like placing toys on and off the top of a dresser.

While it will never replace in-person sessions, Jozmin loves the webcam option because it saves time spent commuting. She thinks everyone should be able to access telehealth, which can be done on the phone or online.

“That may be perfect and all that person needs, because every child or every person’s condition doesn’t look the same,” she said.

Zain Jackson
Eight-year-old Zain Jackson receives therapy from both La Rabida Children’s Hospital and her school. Her mother, Jozmin Jackson, said these services greatly improve her daughter’s life. (Courtesy of Jozmin Jackson)

But unless the Illinois legislature steps in, this convenience may not be widely available after the pandemic.

Telehealth has grown rapidly this year as patients and health care providers have sought ways to reduce nonessential office visits and close contact due to COVID-19. Thanks to an executive order in March by Gov. JB Pritzker, insurance companies regulated by the state are required to cover telehealth appointments like any office visit.

The state also expanded telehealth coverage for Medicaid and Medicare patients. At the same time, the federal government loosened restrictions on telehealth.

While there’s no single tally of telehealth appointments in Illinois, providers here are reporting high numbers. Last year, they barely offered telehealth services.

Nationwide, Medicare and Children’s Health Insurance Program (CHIP) patients received 34.5 million telehealth services between March and June, a whopping 2,600% increase from last year, according to data from the Centers for Medicare & Medicaid Services, a federal agency.

Pritzker intends to renew the executive order he introduced in March, according to his office.

But once the pandemic and the governor’s order come to an end, it’s possible that Illinois would revert to the prior rules, and health care providers would not be reimbursed for the same services at the same rates. That’s why many in health care are already pushing for legislation to make expanded telehealth access and coverage a permanent thing.

Doctor typing on keyboard
Howard Brown Health doctor Alfred Torrence treats patients statewide from his North Side home. He said telehealth’s expansion during the pandemic allows them to treat LGBTQ patients that may be far off from an affirming provider, people with disabilities and those who don’t have reliable transportation. Katherine Nagasawa / WBEZ

Why doctors support telehealth

Experts say while telehealth expansion has mostly been a response to COVID-19, it’s also a glimpse into the future of health care as technology improves and patients and providers become more comfortable with virtual appointments.

Simple convenience is a selling point for some patients. But telehealth can be a major benefit for patients who have conditions that make it difficult to leave home or don’t have access to transportation. In rural Illinois, patients may live hours from the nearest specialist covered by their insurance plan. They may not want to lose a full or half-day of work to see a doctor in person.

Kari Wolf, a psychiatrist at Southern Illinois University’s School of Medicine, said telehealth can’t eradicate those struggles, but it can help ease the burden on patients. The school has done more than 50,000 telehealth appointments with patients statewide this year through October, she said.

Wolf is concerned about the impact if telehealth availability and cost coverage revert to pre-pandemic levels.

“People are finally getting some of the care that they need, and they’re gonna be left in the lurch because many of the patients we take care of are a long ways away from us and don’t have transportation,” Wolf said. “If the executive order ends and there’s no legislation to fix this problem, these individuals are just going to go back to not receiving care, and that’s not right.”

At Northwestern University Medicine, hematologist oncologist Dr. Robert Eisner said cancer patients’ routine checks, like reviewing blood tests or CT scans, are done easily over the phone, saving them time and money. Plus, patients who have compromised immune systems can reduce the risk of exposure to the coronavirus by using telehealth.

Howard Brown Health, Chicago’s leading health care provider to LGBTQ patients, said telehealth offers more consistent care for HIV/AIDS patients and young, geographically isolated transgender people.

Dr. Alfred Torrence is doing most appointments from his home on the Far North Side. Howard Brown’s telehealth program was launched in March and uses Zoom to communicate with patients. But if patients don’t have a computer or smartphone, Torrence will do a phone call instead.

He said telehealth is not only popular, but deeply fulfilling for him personally.

“I think this niche service has really closed the gap for a lot of our patients who are having trouble accessing care,” he said. “It’s satisfying to see this group of patients that we couldn’t otherwise access. I think patients are extremely grateful to be able to get health care from the comfort of their own home, or their car.”

Torrence said Howard Brown has decided that if Illinois doesn’t make coverage of telehealth services permanent, it will continue offering the service even though it “would certainly” put a financial strain on the institution.

Dr. Alfred Torrence Side
COVID-19 has loosened restrictions beyond telehealth access. Dr. Alfred Torrence from Howard Brown Health said during the pandemic, he’s been able to treat some patients in bordering states, which helps HIV/AIDS patients and transgender people who may not be able to easily access the medications and care they need. Katherine Nagasawa / WBEZ

Experts aren’t sure how telehealth could impact health care costs

If telehealth is so useful, why did it take a global pandemic to use it on a large scale?

For years, experts say the federal government and insurers have worried that telehealth could drive up health care use and costs, estimating it could lead to billions in spending. There’s been a concern that an escalation of telehealth use would come primarily from Medicare, which serves millions of people.

Early data show those assumptions about cost increases aren’t necessarily true.

Frank Micciche of the National Committee for Quality Assurance analyzes insurance trends. He said the pandemic forced the adoption of telehealth on a wide scale, accelerating the debate over telehealth and its costs by a decade or more.

His organization convened a task force with the American Telemedicine Association and the Alliance for Connected Care during the pandemic to look at data from hospital systems across the country, including Stanford and Johns Hopkins, and found there wasn’t a massive increase in overall health care utilization. Telehealth largely took the place of in-person care, instead of increasing the overall number of appointments.

“It would have been a great indictment of telehealth or a confirmation of those fears if during COVID, when telehealth was unleashed, costs went through the roof,” Micciche said. “That would have been a death knell for telehealth. We absolutely did not see that.”

But Micciche said these early findings are not conclusive because it’s not known how expanded telehealth would function outside of pandemic conditions, where many people may be deferring their care. It’s more of a confirmation that the worst-case scenario isn’t happening, he said.

Right now, during a national health emergency, there’s not much concern about the cost differences between office and telehealth appointments, he said. Most providers are getting paid for telehealth appointments at the same rate as office visits.

But Micciche said health care payers will eventually look at the costs to see how they’ll cover them in the future.

Blue Cross Blue Shield Illinois said in a statement that it is “committed to telehealth as a mode of health care delivery both during pandemic and beyond.”

In an email to WBEZ, a Blue Cross spokesperson added, “Telehealth can help to improve the health of our members when delivered appropriately. We continue to closely monitor the evolving health pandemic and health care claim trends to evaluate and determine how best to support members, employer groups, communities and providers delivering care in the future.”

Telehealth gaining attention in Springfield

In September, nearly 20 health care groups and patient advocates wrote to Illinois lawmakers urging them to take action and make equal compensation for in-person and virtual appointments a state law.

Over the summer, lawmakers ran out of time to negotiate a bill that would have expanded telehealth access for mental health services.

State Rep. Thaddeus Jones, D-Calumet City, chairs the Illinois General Assembly’s insurance committee. He said before lawmakers take up equal coverage for telehealth services, they want to address the issue of equal access.

Black, Latinx and senior patients don’t always have a stable internet connection and may miss out on telehealth access, Jones said. He wants to create a more equitable system for patients and providers, and since the governor’s executive order is likely to be in place for the foreseeable future, Jones believes there’s no rush.

He said lawmakers may hold a virtual hearing to review possible telehealth changes.

“I would rather do it in small phases and do it right as opposed to do a big bill and get it wrong and change it every six months,” he said. “God makes no mistakes and this pandemic that happened made us focus on what we need to do for our health care, what we need to do for residents who are suffering and how to deliver services.”

It’s hard to know when lawmakers will return to Springfield. The fall veto session was canceled due to a worsening COVID-19 situation in Illinois. Whenever the legislature resumes, advocates are crossing their fingers that Jones and others will take up telehealth.

Vivian McCall is a news intern at WBEZ. Follow her @MVivianMcCall.